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EPtalk by Dr. Jayne 2/6/20

February 6, 2020 Dr. Jayne No Comments

Apparently some Advanced APM payments are going to be slowed for some providers as CMS is missing the banking information it needs to send the payments. The profiles of nearly 2,800 physicians are lacking, but I doubt those folks are likely to see the entry in the Federal Register that includes links to documents where providers can verify if they are on the list. Providers have until February 28, 2020 to submit updated banking information. The bonuses are for the 2017 performance year, so some of those providers may have retired or otherwise left practice.

Missouri is apparently going to try to get it in gear this year, as the state legislature has introduced bills to finally try to create a statewide prescription drug monitoring program. It’s the only state in the nation without such a database, although the St. Louis County database is used by a good chunk of the state in an attempt to provide better care for patients despite the actions of previous legislatures. Several state senators have said they’ll try to block it with a filibuster, and if they do, I hope their constituents think twice about voting for them again.


My practice’s “just in time” ordering habits have bitten us, as there has been a surge in mask purchases due to the novel coronavirus outbreak. Masks are apparently on backorder and our supplier isn’t sure when they’re going to be getting any, so we’re no longer giving them to patients and some offices are out completely.

I find our administration’s response to the issue to be lackluster since influenza is still a big issue in the community, having killed more than 10,000 people in the US. Some leaders act as if contracting the flu is just a given, and many of our employees are allowed to stay at the office working even though they should be at home resting. Yet another reason I’m keeping my eye out for a new clinical gig. There’s always telehealth, where my risk of being coughed on by a patient or colleague is zero.

Speaking of telehealth, some of the opposition I hear with regard to that particular care delivery paradigm revolves around “giving Z-packs like water.” The telehealth organization I work with is very particular about antibiotic stewardship and providers are monitored to ensure that antibiotics are given appropriately. I was glad to see some recent analysis on how traditional practices fare in this regard. The study looked specifically at Medicaid claims data over a 10-year period and found that nearly 45% of antibiotics lacked a clear indication for their use. Almost 28% of prescriptions had no associated office visit. The data was from 2004 through 2013, before the rise of telehealth and long ago in the dim ages when patients simply called the office and relayed their symptoms. Of those prescriptions that had an associated office visit, 17% of them had a diagnosis that was not infection related.

The authors note that current strategies to reduce unnecessary antibiotic prescriptions are targeted at the office visit level. However, I would argue that EHRs could augment this by flagging visits where providers prescribe antibiotics with no associated visit. Although an actual warning might be annoying, it would be fairly easy to report on the data and present it for clinicians to review and see how they compare to their peers. Of course, as virtual visits occur, there would need to be further sub-categorization to review those virtual visits specifically for rates of antibiotic prescribing. Other feedback could include in-visit alerts that an antibiotic has been prescribed with no corresponding appropriate diagnosis.

Other beneficial interventions fall in the realm of public health, which as we know is underfunded. Greater patient understanding of when antibiotics are indicated and how to take them appropriately would be the best intervention. I still see too many patients who “took a couple of leftover amoxicillins” before coming to the urgent care for evaluation, which is a failure not only in the current situation, but also in the previous episode of care. Providers also need to know how well they are performing in this regard. I know many physicians who don’t have a clue what their metrics are for antibiotic treatment of respiratory infections, and that’s a shame.

As a blogger, I read a lot of other blogs and the best one I saw this week was Jacob Reider’s, titled: “When sponsored CDS is a crime.” His commentary on the Practice Fusion debacle sums up what he calls “the tension between better health and better profit.” Apparently he had a ringside seat for some initial exploration of the slippery slope of sponsored clinical decision support that led to specific elements of the 2014 Edition of the Certification Criteria for Health Information Technology. He recalls a lunch meeting with Practice Fusion’s then-leader Ryan Howard where they discussed some of the ethics around clinical decision support. Reider is clear that he doesn’t think the opioid situation happened on Howard’s watch, and gives us some visibility into the CDS that was actually in the application. It’s well worth the read.

I also enjoyed this brief Bloomberg Law summary of the HIPAA-related issues that prevent physicians and patients from texting one another. The reality is that it’s time to update HIPAA. The world has changed significantly since the law was passed in 1996. The internet was just a baby then (Netscape Navigator, anyone?) and many people could barely dream of email, let alone APIs and Netflix. In case you’re wondering, other notable things from 1996 include the debut of the Motorola StarTAC flip phone, Dolly the cloned sheep, Nintendo 64, and Tickle Me Elmo.


From Longtime Reader: “Re: app data. Concerns about what happens with our data as we sign up for apps are worthy. That being said, with respect to the big corporate health systems (whether ‘not-for-profit’ or not), the cat has long been out of the bag. We sign away our rights to control our data under duress or blinded by bureaucracy the moment we cross the threshold. Indeed, my primary care doc’s front desk has a signature pad, with no visual presentation of what one is signing for, that memorializes the act, with only some mumbling by the lovely front desk staff about its significance.” I’ve taken to signing those signature pads with something that either only vaguely resembles a signature, or is fully legible but not my name. I’m still waiting for someone to notice.


My HIMSS prep is in full swing as I continue the quest for cute shoes that are comfortable as well. They have to work from day to night as I transition from the expo hall to the afterparties, which is a tall order for any footwear. If you have any suggestions, let me know.


Email Dr. Jayne.

Morning Headlines 2/6/20

February 5, 2020 Headlines 4 Comments

VA’s Wilkie: EHR modernization unimpeded after Byrne’s removal

VA Secretary Robert Wilkie assures members of the press that the departure of Deputy Secretary James Byrne will not impact the department’s transition from VistA to Cerner.

Google Arm, Bain Lead $100 Million Infusion for Health-Data Startup

Patient registry analytics firm Verana raises $100 million and acquires data science company PYA Analytics.

Epic and about 60 hospital chains come out against rules that would make it easier to share medical info

Nearly 60 health systems sign off on a letter written by Epic CEO Judy Faulkner urging HHS Secretary Alex Azar to revise the proposed interoperability rules in light of their patient privacy concerns.

Our Path Forward

Consumer genetic testing company Ancestry announces it will lay off 6% of its staff, following a similar move made by competitor 23andMe several weeks ago.

Readers Write: Value-Based Care Can Work When High-Touch, Personalized Care is the Strategy

February 5, 2020 Readers Write No Comments

Value-Based Care Can Work When High-Touch, Personalized Care is the Strategy
By Adam Sabloff

Adam Sabloff is founder and CEO of VirtualHealth of New York, NY.


Humana recently released some noteworthy figures related to the company’s value-based care programs. An annual review of the health plan’s efforts reported 27% fewer hospital admissions and 14.6% fewer emergency rooms visits compared with traditional approaches.

That’s good news for the healthcare industry in terms of the sizable investment it has made into evolving pay-for-performance models over the past decade, especially in light of early studies that suggested lackluster returns. In fact, one 2016 study published in the British Medical Journal found minimal evidence to support the theory that value-based care models impacted mortality rates.

The question now becomes: What is driving Humana’s results?

Simply put, the payer’s model is much more targeted than early, broad-stroke approaches to value-based care. They have implemented infrastructures and workflows that identify and address not only the clinical needs of patients, but also social determinants of health that may be keeping members from following through with care plans. This strategy is enabling Humana to achieve higher-touch, more personalized care.

It’s an imperative differentiator that healthcare stakeholders need to embrace heading into the next decade. At a high level, the industry acknowledges that it is on an unsustainable financial course. Yet, alarm bells should be ringing loudly amid concerning statistics related to the silver tsunami, the rapidly-growing aging population that is characterized by a high percentage of complex, chronic conditions.

Consider the following figures:

  • The US Census Bureau projects that by 2030, one in every five residents will be of retirement age.
  • 85% of older adults have at least one chronic health condition and 60% have at least two, according to the National Institute on Aging.

Demand for long-term services and supports (LTSS)—an area of high-touch care that currently supports more than 12 million elderly and those living with disabilities —will increase in tandem with the aging population. Consequently, providers and payers must embrace the concept of whole-person care models that consider not only broad clinical strategies that promote wellness, but all the socioeconomic needs of each patient. For instance, Humana attributes much of its success to its ability to identify challenges stemming from social determinants of health—such as food insecurity or social isolation—and help patients access services and make better health choices.

Having insights into social determinants of health (SDoH)— the non-clinical factors that make up 80% of overall health—will continue to characterize success with value-based care, which is crucial for healthcare stakeholders to know. Broad-based approaches to improving population health that may promote regular wellness checks and follow-ups only go so far. In the case of LTSS, many elderly patients who live alone and are no longer able to drive will have difficulties picking up prescriptions or getting to doctor’s appointments. Addressing their lack of transportation can have a significant impact on readmission rates and emergency department visits.

In addition to whole-person care, providers and payers need to address the 5% of patients who require critical, complex, and chronic care, who account for approximately 50% of total spend. After recognizing the shortcomings of traditional care management models implemented alongside legacy technology, some stakeholders are turning to a “wedge” strategy that addresses the needs of complex care populations. The approach carves out the subsets of their member population that have complex care needs and places them on an auxiliary tech tool that surrounds them with a comprehensive care ecosystem capable of effectively addressing their needs.

The healthcare industry has made enormous strides over the past decade to usher in better approaches to care, and there have been many lessons learned. One important lesson is that optimal care considers the whole person, and care managers must have insights into facets impacting outcomes—clinical, behavioral, and social—to impact performance in a meaningful way.

As providers and payers turn the corner into a new decade, it’s important that all reflect on successes, failures, and new opportunities, acknowledging and embracing the promise of high-touch, personalized care for complex patient populations.

Readers Write: Fixing What Ails Healthcare

February 5, 2020 Readers Write No Comments

Fixing What Ails Healthcare: A Checklist for Building a Modern Primary Care System
By Ray Costantini

Ray Constantini, MD, MBA is founder and CEO of of Portland, OR.


For years, the industry has been struggling to find solutions to help fix what’s broken in primary care. There’s been an influx of urgent care centers, retail health clinics, and video telehealth services to address the growing patient load, offer more convenient access to care, and help stem physician burnout. While these alternatives are now commonplace, the state of primary care has actually gotten worse instead of better. 

The healthcare sector is plagued by a shortage of primary care physicians. Existing providers are retiring or leaving practice because of burnout, and there are not enough interested medical students to take their place. Between 1996 and 2007, the number of medical students going into general medicine declined as much as 61%.

Making matters worse is that there are even greater demands on primary care providers’ time. The Affordable Care Act added millions of more insured patients into the mix just as the aging population needed more care. Add to that the burden of exponentially more administrative tasks, which take providers’ time away from seeing patients. 

With primary care resources on the decline and waits for appointments sometimes exceeding 50 days, urgent care centers and retail clinics saw opportunities to jump in to offer supplementary services. The number of urgent care centers exploded during the last decade, reaching more than 8,000 nationwide by 2018, and the number of retail clinics doubled. But even these vast amounts of new options have been unable to ease primary care burdens.

Others have turned to video visits to streamline provision of care and eliminate the need to travel to doctors’ offices. But in reality, video telehealth is equally problematic for providers and patients. In fact, video technology often adds another layer to delivering care. To prepare for a 20-minute “visit,” a provider must go to a location where the patient’s privacy won’t be compromised and then set up the equipment. Plus providers still have the same administrative tasks that accompany an in-person visit. On the flip side, video may not be a viable alternative for patients who lack broadband services or who may not be tech savvy.

Even though they value the convenience of these walk-in clinics and video, a recent survey found that patients still overwhelmingly prefer to receive care from their own provider or any healthcare provider rather than from tech companies or retail centers. 

So what can primary care providers do to ensure their practice is on the right track to deliver 21st century care? Here’s a checklist that will help health systems meet the needs of modern patients, while also reducing their administrative burdens:

  • Survey resources. Which resources are being underutilized? Which are overburdened? Where can shifts be made to increase productivity?
  • Embrace a care team approach. Staffing each step of the care pathway appropriately allows everyone to practice at top of license. Introducing virtual care team members multiplies that positive impact.
  • Use technology where it makes sense and for what it does well. Automate the repetitive tasks to let machines do what they do best and free up humans to practice the art of medicine. With an assist from useful technology, high-quality care can be delivered in less than two minutes for conditions that account for about 60% of primary care visit volume.
  • Be open to change. Just because it worked 100 years ago doesn’t mean it works today or that people still want to operate that way. Not everyone is resistant to change. Many are likely clamoring for it.
  • Link bricks with clicks. Integrate online offerings with in-person ones. Whether a patient gets care virtually, in a clinic, or in the emergency department, every provider should benefit from access to the most up-to-date and accurate health record.
  • Find a partner that can help solve challenges today and in the future. Innovation matters, but the technology must be human-centered and configured to address each practice’s unique issues.

Modern primary care must be on-demand, which means not just when patients want it, but from wherever they are — home, school, work, or even the bus. Technology, such as asynchronous virtual care, already exists to make this possible. Practices now must embrace change and evaluate how they can evolve to be true game-changers in primary care.

Morning Headlines 2/5/20

February 4, 2020 Headlines No Comments

Cerner Reports Fourth Quarter and Full Year 2019 Results

Cerner reports Q4 results: revenue up 6%, adjusted EPS $0.75 vs. $0.63, beating analyst expectations for both.

Hinge Health Raises $90M For Digital Physical Therapy Platform

Hinge Health, an employer-focused digital physical therapy company, raises $90 million in a Series C funding round that increases its total to $126 million.

Premier Inc. to Acquire Acurity and Nexera Businesses from the Greater New York Hospital Association

Premier acquires two healthcare supply chain companies – Acurity and Nexera – from Greater New York Hospital Association for $292 million.

News 2/5/20

February 4, 2020 News 4 Comments

Top News


VA Secretary Robert Wilkie fires his #2, Deputy Secretary James Byrne, due to “loss of confidence in Mr. Byrne’s ability to carry out his duties.”

Byrne was the VA’s highest-ranking official whose responsibilities included its Cerner implementation and other computer projects. He said in November that either he or Wilkie would make the decision of whether Cerner will be ready to go live at two pilot sites on March 28. Byrne expressed confidence in November that the scheduled go-live at Mann-Grandstaff VA Medical Center (WA) and Puget Sound Health System was on track.

Axios reports that the White House was not happy with the VA’s handling of a sexual assault complaint, leading Wilkie to ask for Byrne’s resignation.

The VA did not respond to press inquiries about who will take responsibility for its Cerner project.

Byrne is a United States Naval Academy graduate. He was deployed as a United States Marine infantry officer, served as a Department of Justice prosecutor, and was counsel to the OIG office that monitored the federal government’s $52 billion Iraq rebuilding program. He was the VA’s General Counsel for two years before being confirmed as VA deputy secretary in September 2019. He held that job for 20 weeks before being fired Monday.

Reader Comments

From Ghost in the Machine: “Re: Cerner in Europe. Millennium is being pulled from Spain, Portugal, and France. They are also trying to find a buyer for the Siemens product in Spain and Portugal. That leaves no product to sell, so no need for sales teams and eventually everyone else. It’s not GDPR driving these actions, it’s nearly non-existent margins.” Unverified. UPDATE: CompuGroup Medical announced Wednesday morning that it has acquired several Cerner applications that are marketed in Germany and Spain — Medico, Soarian Integrated Care, Selene, and Soarian Health Archive, for which CGM paid $250 million.

From NFL Fan: “Re: Kansas City. Congratulations to Cerner and the other HIT vendors there on the Super Bowl win!” I’m glad that elitists who see the Midwest as faceless flyover country — including many who don’t know or care that two adjacent states confusingly have their own respective Kansas City – might have learned something (beyond lip synching shamelessly while booty shaking admirably) in watching the drought-breaking Chiefs win. KC area schools have cancelled Wednesday’s classes to allow customers to proudly cheer their taxpayer-supported entertainment vendor and its 20-something-year-old, possibly concussed employees who didn’t voluntarily choose to live there, so try not to whack someone while doing that questionably sensitive tomahawk chop thing. For me, I would avoid the adulatory, freezing parade masses and instead have some Jack Stack brisket and burnt ends with a Boulevard beer. Several health IT companies make the Kansas City area their home, with some of them off the top of my head being Cerner, Netsmart, and WellSky.

HIStalk Announcements and Requests


I emailed the HISsies ballots yesterday to HIStalk update subscribers. Voting is tied to those individual email addresses, so non-subscribers can’t vote (to prevent ballot box stuffing). The nominees came from reader submissions, so blame yourself if you don’t like the choices but didn’t bother to nominate your own. Voting so far has yielded few surprises despite heavy voting action in the “worst vendor” category.


Speaking of voting, please take a couple of minutes to fill out my annual reader survey. I sit in an empty room filling up an empty computer screen every day, so this is my one chance each year to see who’s out there and how I can do a better job of meeting your needs. I always get a lot of good ideas from reader responses. I’ll sweeten the pot by doing one or more random drawings for a $50 Amazon gift card.


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

Acquisitions, Funding, Business, and Stock


Cerner reports Q4 results: revenue up 6%, adjusted EPS $0.75 vs. $0.63, beating analyst expectations for both.


Hinge Health raises $90 million in a Series C funding round, increasing its total to $126 million. The company styles itself as “the world’s most patient-centered digital hospital” in the form of wearables, personalized exercise plans, and health coaching for back and joint pain, paid for by employers.  

Premier acquires two healthcare supply chain companies – Acurity and Nexera – from Greater New York Hospital Association for $292 million. The companies offer group purchasing and supply chain consulting, respectively.

I care even less about McKesson now than when they were a crappy HIT vendor who bailed out, but just in case you still own shares, the company reports Q3 results: revenue up 5.3%, adjusted EPS $3.81 vs. $3.40, beating earnings expectations.


  • University of Alabama at Birmingham Health System will implement TransformativeMed’s EHR-embedded worfklow and alert notifications apps.
  • Norton Healthcare chooses Appriss Health’s PMP Gateway to integrated prescription drug monitoring program information into its EHR.
  • MedStar Health joins Cerner’s Learning Health Network, which sells de-identified patient data to drug companies, as its first health system customer. The program was started in August 2019 in conjunction with Duke Clinical Research Institute. 
  • Health plan Regence will offer members chat-based, around-the-clock access to doctors using CirrusMD’s Ask a Doctor app.



Greater Hudson Valley Health System (NY) promotes Craig Filippini, MBA to CIO.


Chris Morrish (NaviHealth) joins Cohort Intelligence as SVP of enterprise sales.


Identity and data exchange vendor 4medica hires Jorge Nobregas (Siemens Healthineers) to the newly created position of SVP of sales.

Southwestern Health Resources promotes Brian Coffey, PhD to SVP of data insight and innovation.

Announcements and Implementations


Medicomp Systems and Emtelligent will partner to develop clinician workflow and usability solutions based on Medicomp’s Quippe clinical data engine and Emtelligent’s medical natural language processing engine. The first co-developed solution is in beta testing and will be released this quarter.


KLAS reports on its November 2019 patient engagement summit that drew 20 provider and 19 vendor attendees. Early high-level success stories involve matching patients to community programs; providing patient care reminders; making visits easier with pre-visit videos, appointment reminders, online rescheduling, and online urgent care appointment scheduling; and increasing patient portal use.


LOINC pre-releases codes for coronavirus.

Life and health reinsurer Reinsurance Group of America announces an underwriting risk score service for life insurers that performs real-time analysis of EHR and medical claims data.



China admits the first patients to its 1,000-bed coronavirus hospital that was built in 10 days by a crew of 7,000 workers in Wuhan. A second 1,500-bed hospital will open this week. Clinicians will connect to a Beijing hospital using a video system that was installed in less than 12 hours, while medical robots will transport drugs and specimens.

Interesting: Memorial Sloan Kettering Cancer Center has hired a new CIO with no healthcare experience (Atefeh Riazi, who held that role with the United Nations) who will report to the chief digital officer it hired in November 2019 (Claus Torp Jensen, who came from CVS Health and Aetna). Former VP/CIO Pat Skarulis has apparently retired. MSKCC’s federal tax forms show that Skarulis was one of the higher-paid CIOs among non-profit health systems at $1.4 million, joining at least a dozen of her MSKCC peers in the million-dollar club. I also note from that tax form (from the 2017 tax year) that former IBM CEOs Ginni Rometty and Louis Gerstner both sit on MSKCC’s board and IBM was one of its top five contractors at $4.9 million.


In England, NHS hospitals are installing “sleep pods” to allow doctors and nurses to take short naps during their shifts, with an average stay of 17-24 minutes. American company MetroNaps makes the pods, which include soothing music, lights, and vibrations. Sleep medicine experts say it’s unreasonable that air traffic controllers are required to take a 30-minute break every two hours to avoid mistakes, but NHS caregivers rarely get time to recharge.

Sponsor Updates

  • Optimum Healthcare IT publishes an infographic titled “Year in Review: 2019 Healthcare Data Breaches.”
  • ONC recounts the effectiveness of the Patient Unified Lookup System for Emergencies (PULSE) powered by Audacious Inquiry during the California wildfires last fall.
  • PatientPing’s national network of Next Generation ACO providers earns over $150 million in savings for 2018.
  • AdvancedMD will exhibit at the NILA Mid-Winter Meeting February 7-8 in Scottsdale, AZ.
  • BlueTree adds Epic MyChart support to its service center capabilities.
  • updates its Upper Respiratory Infection SmartExam modules to include coronavirus screening.
  • CI Security will sponsor the Data Connectors Charlotte Cybersecurity Conference February 5 in North Carolina.
  • ConnectiveRx will expand its campus in Pittsburgh to meet staffing projections that could reach 1,500.
  • CoverMyMeds receives The Medical Mutual Pillar Award for Community Service.
  • CommonWell’s latest blog, “#InterOp in 2020,” features input from Clinical Architecture CEO Charlie Harp and Diameter Health CEO Eric Rosow.

Blog Posts



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Morning Headlines 2/4/20

February 3, 2020 Headlines No Comments

Epic Wins Disability Suit

A federal judge grants Epic’s motion to dismiss a case brought by the National Federation of the Blind, which argued that the company’s software is designed in a way that hampers blind people from effective healthcare employment.

James Byrne out as No. 2 at VA

VA Secretary Robert Wilkie fires Deputy Secretary James Byrne, who was working closely with Wilkie on the department’s EHR transition, due to a “loss of confidence.”

MedStar Health First to Join Innovative Cerner Network of Health Systems to Conduct Clinical Research

MedStar Health (MD) becomes the first member of Cerner’s new Learning Health Network, a collaboration between health systems and clinical research organizations that aims to better enable its members to conduct medical studies.

Curbside Consult with Dr. Jayne 2/3/20

February 3, 2020 Dr. Jayne 1 Comment


I’m in the middle of a rough clinical stretch, with Super Bowl Sunday in the middle of it.

Most of the team members I am working with are young and relatively green. None had worked a Super Bowl shift before. I explained that we would be super busy until the game started, then it would get quiet, and then we would have a rush before closing for the people who stuck it out through the halftime show and then realized that they were sicker than they wanted to be and didn’t want to wait overnight.

I don’t think they believed me initially, but their worst dreams came true when we had seen nearly 60 patients in the first six hours of our shift. Influenza and strep throat were the main diagnoses, along with a smattering of strains, sprains, falls, and lacerations. As predicted, the patient flow dried up 45 minutes prior to kickoff, allowing us to catch up on the many incomplete charts that had accumulated.

I saw an interesting mix of patients, and for the first time, I had a patient who wanted to search my diagnosis on the internet right in front of me because she didn’t believe what I was telling her. I’ve had enough encounters with Dr. Google that it didn’t phase me, but she seemed surprised that what I was telling her was the same as what was on the internet. Eventually she came on board with the treatment plan, but we’ll have to see what she gives me as a rating or whether she leaves a review. I think she was expecting some other kind of care than what we deliver for her condition, but she didn’t say as much explicitly.

I much prefer when patients are clear with their expectations, and if they don’t agree with what you are proposing, that they say so. I asked my scribe for feedback and she said I seem accessible to patients and I am patient with their questions, so she’s not sure either why the encounter went the way it did. We want to empower our patients to be part of their care, but it’s difficult when there is a hidden agenda or when you don’t have all the parts of the story.

Speaking of patient engagement, I had several patients today who were trying to tell me about medications they had taken in the past and referenced their MyChart accounts. The medications were nowhere to be found, with only the current medication list displaying. The patients all said that they could see the older medications previously, which makes me wonder if the health system made a change to their display settings. The health system doesn’t include visit notes in the patient-visible record so that wasn’t an option either, and I couldn’t figure out the medication from what they described.

Regardless, it was frustrating for the patient. Trying to call the pharmacy on Super Bowl Sunday to validate a list of old medications just wasn’t going to happen. If this was the result of a software change, it would be nice for the health system to let patients know that the app would no longer display non-current medications so that they could adapt accordingly.

This is one of the core issues of interoperability. It’s not enough just to exchange the information, but if patients are to make sure of their health information, it needs to be in a format that is not only clinically useful, but understandable. Some of the things we as clinicians have learned to differentiate – such as the SNOMED-based problem list vs. the ICD-driven diagnosis list – are confusing to many non-clinical people. Information needs to maintain the original documenter’s clinical intent.

This is one of the reason I truly love the Intelligent Medical Objects solutions. They allow the clinician to document in words that they (and the patient) understand while still checking the box for the required underlying codes. Patients understand costochondritis a little better than they understand Tietze syndrome, which is just confusing. There also needs to be a way to differentiate episodic conditions that are relevant in an ongoing way (such as recurrent strep throat when parents are adding up the number of episodes that need to happen before their child’s tonsils can be removed) from episodic conditions that can often be just noise in the chart, such as occasional sinus infections, sore throats, or viral illnesses.

Some EHRs have made provisions for this. Providers can flag episodic conditions to move them from the diagnosis list to the problem list if they are pertinent, but that involves human intervention, reducing the likelihood that it will actually happen. Other EHRs require providers to retire diagnoses that aren’t ongoing, which is another step that may or may not actually occur.

Another favorite solution is Quippe from Medicomp, which allows users to highlight a finding and use it to identify encounters across the chart where related findings were documented, which is really cool. Maybe we can combine functionality like that with developing artificial intelligence solutions, marry it to a bot that will parse the chart intermittently and look for patterns that will identify what is relevant for ongoing documentation and what isn’t, and then display the data accordingly.

These kinds of solutions are what innovators should be looking for, not just creating better user interfaces for providers to mark up data. We need to be armed with great tools that look at our usage patterns and predict what we want to see next and how we want to see it. They need to understand our ordering patterns and dynamically create order sets that meet institutional rules, but that also allow us to do our work quickly and with a minimum of distraction. They need to look at how we’re prescribing and ordering and alert us if our behaviors are deviating from evidence-based best practices, especially if our organizations are scoring us against them, which many employers are. They need to be able to predict which patients are trending to higher risk and which can be managed in a more relaxed fashion, without us relying on potentially biased clinical experience or the Han Solo-like “bad feeling” about something going on with our patient.

As for me, the halftime show is wrapping up and we have zero patients on the board, so I’m headed to grab a snack and get ready for the rush.

What’s on your innovation wish list? What would really make your clinicians’ work lives better? Leave a comment or email me.


Email Dr. Jayne.

HIStalk Interviews Dennis McLaughlin, VP, Information Builders

February 3, 2020 Interviews No Comments

Dennis McLaughlin is VP of the Omni product division (Omni-HealthData) of Information Builders of New York, NY.  


Tell me about yourself and the company.

I have been with Information Builders for quite some time, specializing in data and data integration technologies. I have been involved with the healthcare business since we started investing in it roughly 10 years ago. It has become a significant, strategic part of the business. My role is driving the innovation and the technology direction of our healthcare business to match what the market needs and what our customers are looking for.

What are the most pressing analytics needs of health systems?

The biggest challenge that we run into is around data. There’s lots of great movement in the analytics and visualization space, but in healthcare specifically, having a great tool doesn’t do much if you can’t get the data together and work with it in a dynamic and consistent way.

The pressure that we see a lot for organizations is, “I want to do better care management, but I can’t get the pieces and parts of the data in place effectively to be able to do that.” That’s where we’ve been trying to break down some barriers to make it easy for folks to have access to data, have that data be consistent and comprehensive, and to then be able to apply it to their analytics challenges.

How are health systems that are expanding by acquisition making sense of all of the data that starts rolling in from those new organizations and the systems they use?

Healthcare is awesome and gets me excited when I talk about data, because there’s lots of data out there. It’s not that there’s anything wrong with the data that we have, it’s that the systems that run healthcare generally automate healthcare itself. They deal with people or they deal with financials.

When you’re trying to bring the data together and apply it to a set of requirements that weren’t anticipated when the data was collected — for example, almost anything coming out of care management or population health — you need to be able to take that data, apply some level of governance to it, and then be able to answer the questions that the modern healthcare industry is driving forward.

When we started in this business, fee-for-service was the thing. Now everybody’s working under contracts, whether those contracts are guided by CMS or whether they’re guided by the payer. Trying to look holistically at the patient and be able to provide care in a way that makes sense for the patient’s overall benefit and with reduced risk. All of that is driven by data. If the data that we are trying to base those decisions on isn’t good, then the care can’t be good. We don’t know whether or not that patient has had the appropriate level of care, especially in acute care situations and chronic situations. We don’t know what’s happening. The more data we can bring in, make relevant, and make available at the point of care, the more we can bend the curve.

The other side of this is that traditionally a lot of systems, like EMRs, are right there at the point of care, but some of the advanced data and analytics that you are going after don’t really get analyzed until down the road. It’s hard to make an impact for a patient who’s sitting in front of a doctor.

Another of the trends that we are seeing is, how can we take this insight that we’re developing out of the data, start to bring it to a much more real-time perspective, and get that information right there to the point of care?

Are health systems making bad operational decisions or failing to make operational decisions because their data governance is immature?

It would be unfair to be judgmental to folks on decisions that they made, mainly because in many cases in healthcare, unlike almost any other industry, the business of healthcare tends to drive decisions about the technology. The poor IT department is constantly on the ropes reacting to, decisions such as, “We’re going to have a new EMR. We’re going to have a new system to manage these cancer drugs. We’re going to have a new system to manage cost.”

A lot of our IT partners are responding constantly in a reactive way instead of a proactive way. Despite their efforts, even those who are dedicated to data governance recognize that if the chief medical officer makes a strategic decision about a particular automation system, that thing is probably going to happen. What we have to do after the fact is to figure out how to then govern the data that is flowing through that system and the way it interacts with other systems.

It feels at times like our customers are in a constant scramble to balance the needs of the business, while at the same time recognizing — especially those on the data and IT side — that they have a responsibility to ensure that data is of the highest quality. Especially for the organizations where they’re dedicated to making data be a strategic asset in the way that they approach the business, whether that’s related to quality, care management, or any of their initiatives.

A lot of the initiatives of these health systems relate to being the highest-quality provider in the area, or branching out to cover the largest potential population. That takes us back to, do we have data that can support that agenda?

Are health systems using more external data, such as from claims or pharmacies?

Absolutely. The health systems and organizations that we deal with have a voracious appetite for data. They want everything that they can get. They would like to get data from the payers. They would like to get data from labs that aren’t their own labs. They would like to get data everywhere they can.

Probably the number one question we get involves data related to things like benchmarking or feedback loops. A lot of the folks in healthcare have a scientific background. They are paying close attention to what the market is doing, what particular studies are in play, determining the best way to run their business, and figuring out how to best interact with their patients. In those cases, outside data is critical for being able to do that.

The challenge that they have is that in healthcare, while there are interesting sharing points related to data, I’ve always said, “You’ve seen one HL7 implementation, you’ve seen 40.” While healthcare is moving in a direction of being able to share data more effectively, it’s not the easiest thing for these organizations to do. That’s an area where we try and help them alleviate the pain of that challenge.

Are those health systems working toward reaching out to patients and their communities in general in treating them as customers?

Yes. We have worked with some organizations that have been very progressive in that area. From the ability to recognize when people move into town, to paying very close attention to where they site their clinics and their facilities, trying to match the outreach of the organization to the people in the area where they live, and provide services to folks closer to where they live. All of those would be second nature in certain industries.

You look at an organization like McDonald’s. The way it does its siting is high science. This is coming to healthcare. These folks are recognizing that to be able to effectively manage their customers, their patients, and their families, they have to borrow from some of these other industries. You’re starting to see a lot more of the techniques that we typically might see in marketing, advertising, or retail being applied to the healthcare challenge.

I think it’s a great thing. If I know that a particular group of my patient population has a propensity towards needing cardiac care and I don’t have a clinic anywhere nearby, then I’m not servicing them well. Being able to analyze the patient population, being able to analyze the surrounding market and my competitors, and then taking action accordingly gives an organization a leg up in a market that has become pretty competitive.

Are health systems using technology to help them align with independent physicians, or to co-market their services with their technologies, such as being listed in the health system’s physician directory or taking appointments online?

Yes. Ever since the budget deal that created the requirements around technical automation and doctors, we’ve seen a lot of consolidation in the market related to affiliations. Physicians are joining networks that they never would have considered before or are associating with a network.

At the same time, not everyone is going to hire the physicians into an expanded network. We see organizations we deal with range from, “We are going to expand and market to these physicians and get them to join us” all the way to, “We are going to make their experience so seamless and positive that they will want to affiliate with us, and we can provide a lot of efficiencies that the physician or the physician group wouldn’t be able to provide on their own.”

We did an innovation a couple of years ago that we would not have predicted, and that is around mastering physician practices. It’s not just knowing who the physicians are, but knowing where they’re practicing. Physicians are entering and exiting various practices on a much more frequent basis than ever before. It’s super important for us to be able to feed that information, to be able to say that Dr.  Smith is now associated with this other practice even though he spent 10 years at another place. 

That has been a rapidly changing part of the market, although you would normally think that data and information would be stable. It’s been changing a lot and we have spent a lot of innovation to be able to match it. We make it easier for these organizations to keep track of those folks and to be able to market them when they’re affiliated and not necessarily employed by the health system or the health network through its various tentacles. When we looked at our roadmap 10 years ago, we didn’t look at physician stability as something that would become a significant data challenge, but we have experienced exactly the opposite.

Do you have any final thoughts?

We talked a lot about data, the kinds of things that we’re looking at in the market, and how we are responding. The biggest challenge moving forward for both us and the market is, how do we now use some of the initiatives that are being pushed down by CMS and the market in general — things like FHIR – to take interoperability to a whole new level? One of our key themes for this year is to not only be able to access, manage, and govern this data, but now to look for ways that we can get that data, these analytics, and these insights that derive from the data into the systems that physicians, nurses, and health systems are using to be able to improve care. How to give them additional insight, whether that’s related to social determinants or just pure efficiency. 2020 is the year for better ways of getting data into the hands of the folks that can use it to impact care.

Morning Headlines 2/3/20

February 2, 2020 Headlines No Comments

Best in KLAS 2020 Software/Services

KLAS announces its “Best in KLAS Software & Services 2020” winners, with Epic winning top Overall Software Suite for the tenth straight year as well as awards in numerous other categories.

AMN Healthcare to Acquire Stratus Video

Healthcare staffing firm AMN Healthcare will pay $475 million to acquire video-based hospital interpreter provider Stratus Video.

Google-Backed 1Life Healthcare Surges 58% in Trading Debut

Membership-based primary care company One Medical raises $245 million after seeing its shares surge 58% during its first day of trading.

Monday Morning Update 2/3/20

February 2, 2020 News 2 Comments

Top News


KLAS announces its “Best in KLAS Software & Services 2020” winners. Highlights:

  • Epic won top Overall Software Suite for the tenth straight year, scoring 85.9. It was #1 in large hospital EMR, ambulatory EMR in both the medium and large practice categories, practice management in large practices, patient accounting and management in large hospitals, patient portal, and application hosting.
  • Epic also won Category Leader designation for EMR-based interoperability solutions, laboratory information system for large hospitals, medical oncology, and patient flow.
  • Pivot Point Consulting was named top Overall IT Services Firm.
  • Meditech topped the community hospital EHR category.
  • Leading the ambulatory specialty EMR category was PCC, which scored 96.1.
  • Sectra was the PACS leader.
  • CPSI Evident Thrive Patient Management was the most-improved software product, while Cerner Practice Management took that honor in the physician practice segment.
  • The long-term trend away from standalone ancillary systems is obviously complete, as KLAS didn’t even report on pharmacy or radiology information systems and the inpatient LIS category contained only Epic and the distant second-place finisher Sunquest. One of few exceptions was Medsphere Wellsoft, which beat both Epic and Cerner in the emergency department solutions category.

Reader Comments

From Dark Crystal Ball: “Re: Practice Fusion. I searched HIStalk and you predicted this in 2007.” I had forgotten this, but I always enjoy re-reading my frenetic “Time Capsule” editorials, which are now themselves in a time capsule since it’s been many years since I wrote them (while working several jobs other than my health system one, thus the “frenetic” part). I said in the one you found from September 2007:

You’ve seen the faltering first steps of ad-powered physician systems, healthcare social networks, and online references. The approaches have been amateurish, but I guarantee somebody will figure out that the real money will be made by giving drug and medical device companies access to prescribers at the point of decision-making. Pay-per-click gets much more valuable when presented in context to free EMR content and patient-specific information. Say, do you really want to order Drug A? Why not try Drug B instead, especially since this patient has renal problems and we’re offering a special price? Click here for our convincing medical references. In fact, we’ll buy your whole office lunch if you’ll just click OK instead of Cancel.


From Vaporware?: “Re: DoD oversight report on Project Genesis. Takeaways: it provides no updates on previous failures in interoperability, fitness of purpose, and usability, all of which are presumably now part of final testing at Wave Travis. It also notes that patients are at risk because of Cerner’s failure to meet DoD cybersecurity requirements even three years after go-live. Summary: things are improving, like from an F- to F+, after all those billions have been spent.” The high-level summary report for 2019 doesn’t provide a lot of detail, but known cybersecurity shortcomings are obviously a focus.

From Curious: “Re: Cerner. Reddit users say Cerner will lay off employees in its offices in France, Spain, and Portugal in February.” I suggest taking Redditors with a grain of salt, but some of the unverified comments say:

  • Outsourcing will replace some staff in those offices.
  • Millennium has been taken off the market in France, Portugal, and Spain (that seems hard to believe, but I don’t know either way).
  • GDPR may be driving company changes since data stored in non-EU countries (like the US) is a problem for European providers.

From Virtuous Visit: “Re: telehealth. You said before you hadn’t had a virtual visit. Still true?” Somewhat. I’ve reached out to my $70 per month concierge doctor a couple of times for minor, one-time problems, like my first-ever allergic reaction and a swollen toe. He has no incentive to make me come to his office needlessly since he isn’t billing separately, so in those cases, my situation’s description – from a text message sent to his cell phone with or without an attached photo – was enough for him to confidently send in a prescription and follow up afterward. I have few health needs otherwise, but it is empowering to be able to text him at any time on any day, to hear back immediately, and to have a prescription in the drugstore’s hand minutes later and mine not long after that. I trust him to tell me if I would be better off coming in, but most issues aren’t of the “laying on of hands” variety. It’s liberating but unfortunately rare in healthcare to be treated as a paying customer.

From Cloying Aftertaste: “Re: HIPAA covered entities. You aren’t one if you don’t bill electronically.” Correct. My concierge doctor, for example, is not bound by HIPAA since he doesn’t bill electronically using HHS standard formats. People sometimes forget that aspect of HIPAA, probably because most providers send electronic billing transactions. Or they think that HIPAA offers general privacy protection for healthcare data, which it most certainly does not.

HIStalk Announcements and Requests


Two-thirds of poll respondents suspect that Epic is motivated by its own interests and not those of patients in opposing HHS’s proposed interoperability rules.

New poll to your right or here: Which of the following would you check before allowing an app to access your health system-stored patient information?


Welcome to new HIStalk Platinum Sponsor CareSignal. The St. Louis-based company’s platform amplifies proactive care by engaging high-risk patients, providing real-time care team alerts and patient health status reporting via automated, evidence-based text messages or phone calls. Care managers can improve outcomes for any patient, and the platform offers 20 condition-specific interventions for conditions such as diabetes, asthma, and depression. Case studies describe how clinicians use the platform to reduce COPD hospitalizations by 62% while maintaining 80-90% patient engagement and a large, self-insured employer whose employees reported a 28% drop in PHQ-9 depression questionnaire scores in 11 months. Use cases for its automated, personalized support include chronic condition management, behavioral health, maternal health, discharge support, screening reminders, and complementary support. Ten peer-reviewed journal articles have described positive outcomes. Partners include Mercy, BJC HealthCare, and OSF HealthCare. Thanks to CareSignal for supporting HIStalk.

Last chance for HIStalk sponsors – tell me about your HIMSS activities and I’ll include you in my guide.

Listening: new from Canadian rockers Theory of a Deadman. Also: neo-soul from France-based singer Praa, who has both the sound and the look to become a star. I can listen to these while not watching the Super Bowl, the interest in which escapes me given my lack of appreciation for staring at someone else playing games, aka jock porn.


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

Acquisitions, Funding, Business, and Stock


Meditech files its annual report. Highlights:

  • Total revenue was up 1% year over year.
  • Net income increased by 226%, with much of the increase driven by an $89 million gain from the sale of an office building. 
  • Product revenue decreased by 2%, but service revenue increased slightly.
  • Neil Pappalardo owns 45% of the company’s shares. He also is the sole trustee of the company’s profit sharing trust, so he controls 63% of the voting rights.

Healthcare staffing firm AMN Healthcare will pay $475 million to acquire video-based hospital interpreter provider Stratus Video, which reports $34 million of EBITDA on $119 million in revenue. I didn’t realize that the medical translation business was that significant, but laws don’t give providers a choice.

Announcements and Implementations


Intelligent Medical Objects adds coronavirus-related terminology to its content, including 15 new diagnosis descriptions that are mapped to ICD-10-CM and SNOMET CT codes for billing, reporting, triggering clinical decision support rules, and tracking cases.

Privacy and Security

Meadville Medical Center (PA) says an unauthorized party used a hospital employee’s Meditech log-in to access its HR and payroll systems several times.


A New York Times article describes the increasing number of prescription mistakes that result from chain drugstores holding their pharmacists accountable for high productivity metrics and forcing them to work the drive-through window, give flu shots, and answer phones. Among the issues:

  • The stores routinely ignore the prescriber’s dispensing quantity and instead issue a 90-day supply, even for people who are at risk of suicide.
  • Employees are instructed to push patients – in person or via outbound phone calls — into signing up for automatic refills, switching to 90-day supplies, and allowing the pharmacy to contact the prescriber automatically when the prescription expires or refills are exhausted.
  • Doctors are being bombarded by drugstores that use automated systems to call them for refills where none were specified, even for inappropriate medications such as short-term dermatology drugs, forcing them to look up each patient’s record and increasing the chances of mistakes. Doctors report that patients didn’t approve such contact 90% of the time.

Weird News Andy is more tolerant than I of people who are paid to write who nonetheless do it poorly, but he draws the line at this article, which he says contains one of the worst-written sentences ever in “They are a very rare form of ovarian cyst, which are common in women” (the cysts? ovaries?) He also ponders how the writer knew the doctor was smiling behind his surgical mask, which hides his expression.

Sponsor Updates

  • Netsmart will exhibit at the LeadingAge Minnesota Annual Institute and Expo February 5-7 in St. Paul.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Foundation of SMFM 40th Annual Meeting February 3 in Grapevine, TX.
  • PharmaCord will leverage the Surescripts health information network to enhance its patient services technology.Redox releases a new podcast, “Pharmacy of the Future with Alto’s Mattieu Gamache-Asselin.”
  • Abu Dhabi Health Services Company SEHA will implement Vocera’s clinical communication and workflow software at the new Sheikh Shakhbout Medical City.

Blog Posts

HIStalk Sponsors Earning “Best in KLAS” Awards

  • Arcadia (value-based care managed services)
  • Chartis Group (clinical optimization)
  • Dimensional Insight (business intelligence and analytics)
  • Elsevier(care plans and order sets)
  • Experian Health (revenue cycle,  contract management)
  • HCTec (outsourced coding)
  • Impact Advisors (HIT implementation leadership, large)
  • InterSystems (interoperability platforms)a
  • Meditech (acute care EMR, patient accounting and patient management)
  • Nuance (quality management)
  • PCare (interactive patient systems)
  • Pivot Point Consulting (overall IT services firm)
  • Relatient (patient outreach)
  • Strata Decision Technology (business decision support)
  • Waystar (claims and clearinghouse)
  • Wolters Kluwer(clinical decision support, point-of-care clinical reference)



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


Weekender 1/31/20

January 31, 2020 Weekender 2 Comments


Weekly News Recap

  • Allscripts will pay $145 million to settle federal allegations that EHR vendor Practice Fusion, which it acquired two years ago, accepted $1 million in opioid prescribing kickbacks and falsified its ONC EHR certification.
  • Imprivata acquires mobile device access management technology vendor GroundControl Solutions.
  • HHS Secretary Alex Azar and CMS Administrator Seema Vema vow that profit-protecting “bad actors” won’t waylay HHS’s propose interoperability rules.
  • The private equity owner of wearables-powered employee wellness vendor VirginPulse reportedly is preparing to sell the company for up to $2 billion.
  • imaging and radiology workflow systems vendor Intelerad sells a majority stake in the company to an investment fund manager.
  • A Health Affairs blog post describes the funding and operational challenges of the Indian Health Service in maintaining and eventually replacing its obsolete, VistA-based RPMS enterprise and EHR system as the VA moves to Cerner.
  • Epic makes a rare public statement in explaining that its opposition to HHS’s proposed interoperability rules involve the potential of app vendors to misuse patient data and for patient family information to be inadvertently shared without the permission of those individuals.
  • Evive acquires WiserTogether.

Best Reader Comments

Healthcare data breaches since 2014 have exposed over 200,000,000 records. There are indications that there are far more health systems with Google-Ascension type of agreements than have been publicly acknowledged. The top five private DNA testing companies have the complete genome of 29 million customers with no restriction on how that data may be used or sold, and their follow-on survey questions only add more information on personal lifestyle and family history. So, what is the chance that we’re discussing whether or not to lock the barn door when a walk around the barn reveals the back wall is already gone? (BillyM)

Patients have some limited recourse with breaches, and healthcare organizations have legal requirements to attempt to prevent them. Patients have zero recourse if an app sells their data per the terms of service. People sue hospitals all the time for privacy breaches. Good luck suing an app after approving the click-through agreement. (Elizabeth H. H. Holmes)

Most care delivered to the under-65 crowd is episodic. The only people who need to consistently monitor and interact with their data are over 65 or the caregivers of the over 65. Demand for tech solutions is less among that crowd. Consumer apps in healthcare are really really hard. Most are ad supported, which means they increase utilization (more eyeballs, more ads.) (BankeMeLater)

What did happen on the financial side was fairly open access to data by consumers, who could send it to whatever financial app they wanted. Sure there were some issues, but the world didn’t end. Maybe it’s time to make the same leap of faith with healthcare data. (Bob Smith)

A huge wildcard in the plans for the proposed HHS rule is Google v. Oracle. If the Supreme Court upholds the Circuit Court’s ruling, EHRs will have to live a in a regulatory landscape where both of the following are true: (a) their APIs are protected by copyright and they are within their rights to restrict their use and charge fees for such use; and (b) their APIs must also be exposed and offered for free. If the SC upholds the ruling, EHRs will immediately sue arguing that the proposed rule is illegal (and they would be correct). (Elizabeth H. H. Holmes)

HS seems to think that clumsily opening the floodgates will be some kind of cure-all. “If we expose all of the data, it will solve all of our problems”. Sure, go ahead and pretend like Carequality, CommonWell, and CareEverywhere have done nothing for the industry. And go ahead and blame the EHRs, when it’s almost always the IT departments at healthcare organizations that are the gatekeepers. EHR vendors and hospital organizations are bringing up valid privacy concerns, and HHS and others continue to talk past them and make appeals to patient rights to access their data. (Elizabeth H. H. Holmes)

The advertising business model does not work in healthcare. Most developed countries have some sort of ban on medical advertising. The Practice Fusion story is one reason why. Most consumer software is driven by an advertising business model. Facebook, Google search, Android, Gmail, MyFitnessPal, recipe apps, etc. HHS is opening up medical data to these advertising companies. (Goodluck)

Why should Epic and its customers be held responsible under HIPAA for any breach — as an example, to Mychart — but if an app developer who has access to that same data experiences a breach, they are not held to the same standards? The federal government needs to update the HIPAA regulations to ensure that anyone who has access to PHI is held equally accountable for maintaining the privacy and security of that data. (Nael Hafez)

Watercooler Talk Tidbits


The vacated 116,000-square-foot Palo Alto, CA building that served as headquarters for disgraced blood testing company Theranos (and the backdrop for related TV documentaries) has ironically been taken over by the medical school of Stanford, which owns the land in its Stanford Research Park. Theranos was paying $1 million per month in rent. The office from which Holmes led her fraudulent empire still has its bulletproof glass. It has a chemistry lab, which should probably be checked out by experts before using.


Several amusing cardiologists create the Kardashian Index (K-index) in observing the perceived prevalence of fame-hungry cardiologists who lead Twitter chats about their work and medical conferences that appoint questionably accomplished but prolific Twitterati as social media ambassadors. The authors find that the issue is overblown — only 238 of 1,500 cardiologists who practice at the country’s top 100 cardiology hospitals have Twitter accounts, leading the authors to conclude that “tooting your own horn does not necessarily equate with more impactful work.”

Content moderators for Facebook and YouTube are being required by contracted by their employer Accenture to acknowledge that they may experience PTSD from reviewing disturbing content posted by their fellow humans.

An impressively large aggregation of dimwits has decided that “coronavirus” must be associated with Corona beer, leading to a huge spike in Google searches for “Corona beer virus.” That’s pretty funny until you realize that they reproduce, spread their wisdom on social media, and vote.


Super Bowl Sunday brings forth a rash of “avocado hand,” in which unskilled, distracted, and possibly inebriated knife-wielders attempt to turn the stubbornly peeled and pitted fruit (technically, it’s a berry) into guacamole, plowing through 162 million pounds of avocado and quite a few tendons in a single day. Researchers estimate that 50,000 avocado-related knife injuries occurred from 1998 through 2017. Pro tip: the pre-made Walmart guacamole, especially the spicy version, is darned good, has a long shelf life, and may end up costing less than buying avocados yourself, at least when they aren’t on sale.


While you’re sitting in a hospital ED on Sunday waiting to have your avocado-knife tendon injury repaired, watch the Super Bowl for Kansas City Chiefs right guard Laurent Duvernay-Tardif, who signed a $42 million contract extension in 2017 and shortly after graduated from Montreal’s McGill University with an MD and Masters in Surgery after being drafted by the NFL in his third year. He spoke only French but missed the deadline to apply for French-speaking medical schools, so he had to learn English at McGill, one of three English-taught schools in Quebec. He wants to go into emergency medicine, but his career and the limited number of McGill residency spots have placed that plan on hold. The NFL won’t let him include “M.D.” after his name on his jersey.

In Case You Missed It

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Morning Headlines 1/31/20

January 30, 2020 Headlines No Comments

1Life Healthcare (One Medical) Announces Pricing of Initial Public Offering

Primary care company One Medical will price its January 31 IPO at $14 a share for expected gross proceeds of $245 million.

OxyContin maker Purdue is ‘Pharma Co X’ in U.S. opioid kickback probe –sources

Reuters names OxyContin manufacturer Purdue Pharma as the opioid vendor that paid Practice Fusion $1 million to program its EHR to encourage doctors to prescribe its products inappropriately.

Exclusive: SoftBank leads latest Alto Pharmacy funding round at over $1 billion valuation

Silicon Valley prescription technology and delivery vendor Alto reportedly raises $250 million at a valuation of over $1 billion.

Intermountain’s Marc Probst to Receive CIO of the Year Award from CHIME and HIMSS

CHIME and HIMSS honor Intermountain Healthcare CIO Marc Probst with the 2019 John E. Gall Jr. CIO of the Year award.

News 1/31/20

January 30, 2020 News 3 Comments

Top News


Reuters names OxyContin manufacturer Purdue Pharma as the opioid vendor that paid Practice Fusion $1 million to program its EHR to encourage doctors to prescribe its products inappropriately.

Employees estimated that the software change would create 3,000 new opioid patients and $11 million in new opioid sales. Practice Fusion told Purdue in 2016 that the program was working in shifting prescriptions to the drug company’s long-acting opioid product. The the clinical alert fired 230 million times between July 2016 through early 2019.

The Reuters report says Practice Fusion started soliciting Purdue’s business in late 2013, before founder and CEO Ryan Howard was dismissed from the company and was replaced by a former drug sales executive. Howard has recently said on Twitter that no such activity occurred while he was in charge.

Purdue declined to comment, other than to say that it is cooperating with the Department of Justice “regarding a potential resolution of these investigations.”

Purdue filed bankruptcy in September 2019 while it tried to negotiate a settlement of up to $10 billion for its role in opioid addiction. The company sold at least $35 billion worth of OxyContin, with $12 billion of that flowing to the company’s owners, the Sackler family.

Allscripts will pay $145 million to settle charges that Practice Fusion – which it acquired for $100 million in January 2018, a fraction of its previously estimated value — accepted drug company kickbacks from 14 such deals and also obtained EHR certification fraudulently.

Reader Comments

From Doncha Know: “Re: healthcare IT M&A. You once published a very helpful flowchart. Would love to see a current view if you are still maintaining.” Constantine Davides, MBA (now managing director at Westwicke) created the “HCIT Family Tree” worksheet, but he hasn’t updated it since 2015 as far as I know. Vince also did something similar in his excellent HIS-tory series, but it’s also not quite current.

From Tolkien: “Re: Stanson Health founder Scott Weingarten. He seems to have left Cedars-Sinai.” I don’t have his contact information to ask, but his LinkedIn shows he left his Cedars SVP/chief clinical transformation officer position in December 2018, which is odd since he’s still listed on the health system’s website as holding that role. He remains CEO of Stanson Health, now owned by Premier.

HIStalk Announcements and Requests


Monday set a recent record for HIStalk at 10,559 page views in 8,400 unique visits, as folks followed the interoperability and Practice Fusion news. I’ve had only four busier days in HIStalk history, three of which barely passed Monday’s total (the DoD announcement day in 2015 was an outlier that crashed my server):

  • January 20, 2015 (no big news except that Mayo chose Epic and McKesson announced that it was sunsetting Horizon).
  • July 30, 2015 (the DoD announced that it chosen Leidos and Cerner).
  • June 28, 2017 (Nuance ransomware attack).
  • January 18, 2018 (Allscripts ransomware attack).

Reminder to HIStalk sponsors: fill out this form and I’ll include you in my HIMSS20 guide, which will include booth details and anything special you are doing or giving away. Attending but not exhibiting? It’s even more important to fill out the form since we will let readers know how to contact you at the conference.


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

Acquisitions, Funding, Business, and Stock


Imprivata acquires New York City-based GroundControl Solutions, which offers enterprise digital identity authorization and access management for mobile devices.


Silicon Valley prescription technology and delivery vendor Alto reportedly raises $250 million at a valuation of over $1 billion. The company operates only in San Francisco, Los Angeles, and Orange County, CA. The two co-founders – ages 26 and 27 – are former software engineers with no healthcare experience.


Eko gains FDA clearance for several algorithms that, when paired with its digital stethoscopes, will enable providers to more effectively screen for heart murmurs and atrial fibrillation.



Michael Jackman, MBA (Ardan Equity) joins Leido Health Group as COO.


CHIME and HIMSS honor Intermountain Healthcare CIO Marc Probst with the 2019 John E. Gall Jr. CIO of the Year award.

image image

Digital therapeutics and AI-powered health analytics vendor Biofourmis hires John Varaklis (Roche) as chief strategy officer and Peter Braun, MBA (Roche) as chief commercial officer.

Announcements and Implementations


Nuance works with documentation and coding company ZHealth to develop computer-assisted physician documentation capabilities for cardiologists, particularly in the area of catheterization.


Valley Presbyterian Hospital (CA) connects to the CommonWell data-sharing network through its Meditech system.

Government and Politics


Healthcare stakeholders including AMIA, Microsoft, AAFP, Apple, and IBM (and zero EHR vendors) send a letter to HHS and the Office of Management and Budget indicating their support for the proposed interoperability rule, and requesting that it be finalized as soon as possible.


Echoing remarks made by HHS Secretary Alex Azar earlier this week, CMS Administrator Seema Verma says that “bad actors” in the private sector will not have their way when it comes to shutting down interoperability efforts:

It’s important to understand that the disingenuous efforts by certain private actors to use privacy – vital as it is – as a pretext for holding patient data hostage is an embarrassment to the industry … I want to extend that point to the entire industry: the sort of consumer-oriented revolution that will make the healthcare system more affordable and accessible is undermined by those bad actors throughout the system that continue to guard the status quo because it’s in the interest of their short-term profits. The short-sightedness of such efforts is deeply troubling, considering broad frustration with the status quo is the fuel that drives calls for the destruction of the entire private healthcare system. This self-serving mentality must be immediately and permanently retired. The problems of affordability in the health care system are too dire for the American patient to wait any longer.


A federal judge rules that HHS-imposed limits on the fees that providers can charge for providing copies of patient records do not apply when those records are sent to a third party, such as life insurers and law firms. Records release vendor Ciox Health sued the federal government in 2018, arguing that HHS did not have the authority to expand the fee caps that were intended to limit provider charges for patients to obtain copies of their own records.


The Government Accountability Office denies Nuance’s protest of the VA’s $10 billion Cerner contract, which included encoding and clinical documentation improvement that Nuance said should have been bid out separately. Nuance, which is the VA’s incumbent vendor, said an unnamed VA contact told it that the coding and CDI work would be bid as a separate contract, a complaint the GAO found to be unfounded since Nuance tried for months to get Cerner to choose it as a subcontractor and filed its protest only after Cerner declined to do so.



Microsoft will devote $40 million to its AI for Health Initiative, a five-year project that will use artificial intelligence to help partner organizations study, prevent, and treat diseases; prepare for and protect against future pandemics; and reduce healthcare inequities.

Weird News Andy terms this article re-volting. In Germany, an IT worker is charged with 13 cases of attempted murder for convincing women and underage girls to apply electrical shocks to their heads while he watched them on Skype. Police think the man, who told the women he was running a pain management study for which they would be paid, received sexual gratification from watching the video sessions.

Sponsor Updates

  • Digital prescription savings and patient engagement company OptimizeRx signs a multi-million dollar enterprise deal – its largest ever – for 12 months of access to its platform and core set of solutions.
  • Engage will exhibit at the AHA Rural Health Care Leadership Conference February 2 in Phoenix.
  • EClinicalWorks will exhibit at The Pediatric Urgent Care Conference February 5-6 in Universal City, CA.
  • Hyland Healthcare demonstrates enhanced interoperability at the IHE Connectathon.
  • Avaya partners with Noble Systems to enhance its Avaya IX Contact Center solutions with gamification for employee engagement, and data analytics for AI-powered customer contact process automation.
  • InterSystems releases its latest PulseCast podcast, “Julia Riley: Breaking Down the Patient-Physician Divide.”
  • The Chartis Group publishes a new white paper, “M&A Due Diligence: Seven Things the C-suite Should Know About IT.”
  • Health Catalyst partners with the Amplifire Healthcare Alliance to give its customers access to the alliance’s learning modules, and to help the alliance develop additional content for modules.

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EPtalk by Dr. Jayne 1/30/20

January 30, 2020 Dr. Jayne No Comments


CVS continues its transformation by opening Health Hubs in 13 of its Philadelphia-area pharmacies. The model was piloted in Houston and claims to “put patients at the center of their care” by offering services focused on health and wellness. Nurse practitioners staff the Hubs, along with pharmacists, to offer personalized care.

Although CVS leaders expect this to provide “integrated healthcare,” it remains to be seen how nurse practitioners who may have a limited scope of practice and pharmacists who are already in short supply will be able to effectively coordinate with primary care physicians and subspecialists. If they truly want to focus on controlling costs and delivering effective care, I’d like to see the focus on offering evidence-based treatments and avoiding nebulous “wellness” products, such as aromatherapy offerings. CVS plans to offer the model in 17 states by the first part of 2020. If you’ve had a chance to experience the Health Hub, let me know.

Elizabeth Holmes is in the news again as she represents herself in civil litigation, phoning in for a hearing in Phoenix. Attorneys apparently expect to be paid for their work, and since Holmes hasn’t paid her team in more than a year, her attorneys withdrew from the case. This litigation involves alleged personal injury related to faulty blood testing, with either missed diagnosis or unnecessary treatment as the outcome. Walgreens is a co-defendant in the case, and as the hearing began, Holmes stated that she will rely on the arguments made by her co-defendant’s legal team.

HIMSS is around the corner, and I’m missing Las Vegas. Even though I wouldn’t choose it as a personal travel destination, I much prefer it to Orlando for conferences. The access to restaurants and entertainment is much better in Las Vegas, and frankly, I’m just tired of Orlando. Las Vegas is mixing it up with a change to its marketing tagline, with “What happens here, only happens here” being the latest iteration. Supposedly the marketing agency has spent several years working on the new campaign, which seems like a long time.

I’m always looking for the next cool thing to see at HIMSS, and apparently Epic plans to debut “ambient voice technology” from Nuance at the show. I hope the Epic virtual assistant has a sense of humor like Alexa does, when she chides people who say sassy things to her. Supposedly the assistant, called “Hey Epic,” is being used by 20 organizations. If you’re using it, I’d love to report on your experiences (anonymously and confidentially, of course). Drop me a note if you have information to share. At HIMSS, they’re supposed to debut “conversational capture” along with automatic note creation, so it’s definitely on my booth list.

I’m starting to put together my HIMSS social schedule and have an opening due to one major vendor eliminating its client event this year. I haven’t gotten the backstory on why that happened, but it was always a fun party, with all the executives hanging out with the clients, so it will be sorely missed. I’ve already scheduled some lunches and meetings, so if you’re interested in having the HIStalk team report on your event, send the details our way. We’ll do our best to drop by, anonymously of course.

The Food and Drug Administration is warning healthcare providers and consumers about vulnerabilities in telemetry servers and clinical information stations that monitor patient vital signs. Security flaws can allow tampering with the devices to generate false alarms or silence genuine alarms on patient monitors that are connected to the systems. GE notified clients about the issue back in November, but posted additional information on its website this week. Although the FDA isn’t aware of any adverse patient events, GE is recommending that providers restrict access to the workstations, change default passwords, and isolate the affected devices from the wider hospital network. The interesting tidbit of this story is that the vulnerabilities were reported to GE by a third-party organization (CyberMDX) rather than by a client. It is unclear whether GE engaged them for routine vulnerability testing or how they came to be involved.

Precision medicine is a hot topic, but a recent article shows how difficult it can be to translate those results from the realm of research to the real world of patient care. From a panel discussion at the Precision Medicine World Conference, it appears that although the National Comprehensive Cancer Network offers guidelines on genomic testing, they are not regularly followed outside academic settings. Additionally, physicians and patients struggle to interpret the results of some tests. The results can impact not only the patients, but their potentially at-risk family members. Comparing what happens in community settings to the guidelines, only 8% of non-small-cell lung cancer patients and 40% of colorectal cancer patients received testing according to the guidelines. Panelists call for access to genetic counseling, along with a universal EHR, as potential ways to improve outcomes.


I’m intrigued by a new MyAnalytics feature from Microsoft that purports to give me visibility into my work habits. This week’s focus is on “wellbeing,” which it defines as the ability to “disconnect and recharge” as further quantified by “quiet hours” where I don’t have meetings, chats, or calls outside my working hours as set in Outlook. Apparently it knows that I worked on some documents outside my published work hours. Since this account belongs to a large health enterprise and I’m a contractor, I really don’t have work hours, but it’s fascinating to know that Big Brother is monitoring my work habits. I’ll have to see what the rest of my weekly reports reveal.

From Noteworthy: “Re: another tragedy in California. A vineyard spills 100,000 gallons of red wine. That could have satisfied a lot of thirsty HIMSS attendees.” It’s not only an oenological tragedy but an environmental one, as the wine contaminated the Russian River with the potential to damage water quality along its 110-mile route. The amount of cabernet sauvignon lost would fill eight tanker trucks. Officials note that about 20% of the spill was contained with the vineyard using vacuum trucks and a makeshift dam, but the effort ultimately failed.

What’s your favorite HIMSS beverage? Leave a comment or email me.


Email Dr. Jayne.

Morning Headlines 1/30/20

January 29, 2020 Headlines No Comments

Important Notice Regarding Individuals’ Right of Access to Health Records

A federal judge overrules a policy that places limits on the fees providers and businesses can charge patients when they request that their records be sent to a third party.

Using AI to advance the health of people and communities around the world

Microsoft will devote $40 million to its AI for Health Initiative, a five-year project that will use artificial intelligence to help partner organizations study, prevent, and treat diseases; prepare for and protect against future pandemics; and reduce healthcare inequities.

Arkansas Blue Cross and Blue Shield gives $817,000 to upgrade digital health network in state’s rural hospitals

Arkansas Blue Cross and Blue Shield donates nearly $1 million to the Arkansas Rural Health Partnership, which will work with the state’s rural hospitals to ensure they are connected to the SHARE HIE.

HIStalk Interviews Angie Franks, CEO, Central Logic

January 29, 2020 Interviews No Comments

Angie Franks is president and CEO of Central Logic of Sandy, UT.


Tell me about yourself and the company.

I am a healthcare technology veteran. I’ve been in the tech industry for over 30 years. I found myself in this position as CEO of Central Logic after serving on the board for close to four years. The board made the decision to take the company in a different direction and it was a good time for me, career-wise, to step in. I don’t think I’ve ever had more fun than what I’m doing today.

I like to use a couple of phrases. One is healthcare access and orchestration. It’s about moving patients into the health system via acute care, inter-facility patient transfers. Think about a patient who is in a rural facility or one that doesn’t have the appropriate level of acuity to take care of their needs. They need to be moved to a facility that is more appropriate for their condition. We take all the friction out of that process and make it easy to move a patient from one place to another.

What is the process involved with moving a patient from Facility A to Facility B?

With or without our system, it’s always a phone call. The sending physician and the accepting physician get on the phone and have a conversation about the patient to make sure that the patient is in a state where they can be transferred safely. Because the minute the accepting physician says, “Yes, we will take the patient,” they are responsible for that patient’s care until they get to the receiving facility. They are then part of the care team for that patient. If something happens to that patient, you want those conversations documented and recorded.

Without our system, there’s a phone call to the hospital system, into a call center, transferred around, bounced around, nursing station, phone calls back, lots of time delays, and a back-and-forth process before you can get to a decision of, “Yes, we can make that transfer happen.” When you put in technology, workflow, process, and access to data that we enable, you can take what might have been 10 or 15 phone calls and three hours to get a patient transferred down to a phone call or two and 10 to 15 minutes.

What does the receiving hospital review, other than clinical information, before deciding whether to accept the patient?

A transfer center agent takes the initial call. It’s a clinician, usually a nurse, or it could be an EMT. They identify the physician on call who should take the call and make the decision.

There’s the whole clinical piece that you just referred to. Where does the patient need to go based on the condition that they have? Then, do we have availability in this hospital or somewhere else in our system? Identifying that location, making that decision to say, “We’re going to place the patient in this bed, so hang on to that bed for this incoming patient.”

Then there’s the logistics of how we physically move the patient to the system, ordering the transport and getting all of the logistics done for the physical move.

Enabling all of that through one phone call and one number is what we do. When your health system makes it easy for other health systems or for other providers to send an acute care patient to you, you become the first phone call they make every single time. At the end of the day, this is a revenue-generating function for a health system. It helps bring in patients, it brings in the patients they want to bring in, it brings in the right level of acuity to support service line strategies or whatever the growth strategy is for that health system. When you make it easy, the sending facilities call you every time.

What are the primary sources of inpatients other than a hospital’s own emergency and surgery departments?

There are three primary sources — the emergency department, scheduled procedures, and the transfer center. When you don’t have a transfer center, a greater mix of your inpatient admissions come through the ED, which is a reactive way of building volume and driving patients into your health system that you seek to acquire and retain.

When you put a transfer center in place, you start strategically shifting the mix of patients that you have coming in the front door of the health system. More of those patients come in through your transfer center from other facilities that don’t have the ability, the room, or the capabilities and then send those patients your way.

It’s very attributable. It’s a tremendous ROI for every patient who is transferred into the system. When we work with health systems, we look at their current benchmark or baseline volume of transfers and compare that to where they should be given their size and their demographics. We can accurately predict the growth impact of putting in a transfer center, within a narrow timeframe on when they’ll break even on the investment for this type of solution. We can tell them what the net contribution margin impact will be in Year 1, Year 2, and so on.

In the entirety of my healthcare tech career – EMRs, ERP, and physician practice management — it was always a message of better, faster, cheaper. You’re trying to sell an intangible, the soft ROI of efficiency. This is the only time that I can truly say the value proposition that we bring to the health system can be forecast financially and and attributable down to a patient. It’s easy to track and document.

From a clinical perspective, you get superior clinical outcomes when you get people to the care that they need in an efficient timeframe. The patient’s life is in the balance when you’re in the midst of a transfer. These are not healthy people who just need a referral. These are people who are really sick, and they’re sitting in a facility where they can’t get the care that they need. When you can shave an hour or two or even 20 minutes off that transfer time, it can mean the difference between life or death for the patient, or it can mean the difference between a high quality of life after they’ve come through this medical situation and something much more compromised.

How will expanding health systems and the move to value-based care change how health systems manage their available beds?

As we make that shift to a more value-based care environment, this is all about giving the facility and the health system more control over helping the patient or their provider make the best clinical decision as to where that patient needs to be for the care that they need. You can’t manage and control that for high-acuity patients without the transfer center. Otherwise, who is coordinating the care? What is the fulcrum or the point inside that health system for helping make the decisions that are in the best interest of the patient and the system’s capabilities to deliver appropriate care? This is the function inside the health system that would make those decisions in a value-based care model.

I would add that the data that is captured inside of the platform, the technology that we’re providing, is so robust that it allows the health systems to make strategic decisions about capabilities that they should be offering, geographic areas that they should be serving better where transfers are coming or demand is growing, and services that they’re getting asked for that they don’t have the capability to deliver or maybe that have a higher demand than their ability to deliver. It’s a myriad of data elements and trends that allow executives, typically the chief strategy officer, to make strategic decisions for service line offerings for their health system or geographies that they should be serving.

What clinical information does the receiving hospital get from the sending hospital?

The information that is captured comes form the call from sending physician to accepting physician or to the clinician that takes that call. The Central Logic technology becomes like the EMR for that patient transfer. It’s all of the medical record around what status that patient is in when the call comes in. We have clinical protocols built in so you can rapidly capture all of the information about the patient’s current state and any other key clinical information that is relevant, and then the call between the two physicians. All this information is recorded and codified and a summary of that entire transfer record is passed as a PDF into the EMR. There’s always a record of the entire transfer end to end.

That has some pretty significant liability issues associated with it. If you don’t have these calls documented and you don’t have the entire decision-making process captured, you are opening up your health system to exposure to EMTALA violations. Also, oftentimes you can’t document in the EMR for a patient who doesn’t have a chart in your system, and most transferred patients are new to the health system. You’re exposed if something bad happens when you decline a transfer and you don’t have a way to document that the call came in. If the patient’s family sues the health system for denying the transfer and the patient passes away — and we’ve seen cases like this — and there’s no documentation that the call ever happened by the accepting facility, you can be liable for that decision with no documentation to back up why you made it.

You want and need to have a place where you can accept the call, document the condition, save that information, record the conference call between the physicians, and then maintain that record for the longevity of the patient, either in the patient’s chart or in the transfer record transfer system, in the case of of a denied transfer.

We talk a lot about interoperability, which often means sharing past visit records when a patient presents to a different facility. Does the receiving facility get the patient’s active chart, or something like it, from the sending hospital so they don’t have to start over and repeat tests and trying to understand a situation that has already been analyzed?

I just wish that we were at a place, interoperability-wise, where that was seamless. But the reality is that it just does not happen in today’s world. The information would have to come from the sending facility’s EMR. We have to inter-operate with just about everybody because it is fundamental to what we do. We’re talking to parties inside and outside the walls of the health system to facilitate a transfer on every single call. We have had 10 to 15 million patient transfers through our platforms. To broker the data back and forth between the the sending facility’s EMR and the accepting facility is not a problem technologically, but we’re just not at a point in the industry where the systems talk to each other like that. I’m going to just say that in today’s world, that does not happen. It is the information documented on the call.

I have to admit that in my entire health system career, I knew nothing about hospital-to-hospital patient transfers. They always just looked like admissions.

I would echo what you just said. After 30 years in the industry, until I joined the board, I had never even heard of a transfer center inside of a hospital. In fact, it never occurred to me to even think about how patients get to the hospital for the care that they need, outside of the emergency department and scheduled procedures. This is a channel strategy for health systems, but it’s not intuitive. It’s not something that we think about.

Do you have any final thoughts?

We’ve probably had more of a, ”If you build it, they will come” mentality in health systems. This is a more retail-like mindset. “We built it, we have the plant and the facility and the delivery capabilities, now  go out and get the patients in the door who need to be in our health system.” It’s a big financial reward and a clinical outcomes reward for that patient and a much better clinical outcome for the individual. We make it easy.



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