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News 3/13/19

March 12, 2019 News 3 Comments

Top News

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Hill-Rom will acquire mobile clinical communications vendor Voalte for up to $195 million. Hill-Rom hopes to enhance its point-of-care delivery of actionable insights and to drive its growth and margin.

Voalte’s annual revenue is $40 million. It has 200 healthcare customers.


Reader Comments

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From Boston Beanboy: “Re: Salesforce. You might enjoy this article – replace ‘Salesforce’ with any EHR vendor’s name and ‘sales rep’ with ‘clinician.’ It’s the same story.” A biased but interesting article written by  the CEO of a sales platform that runs on Salesforce says sales reps hate Salesforce because the system wasn’t designed for them, it doesn’t help them meet their goals, and it turns them into highly-paid data entry clerks where which they enter the bare minimum of information required for them to collect their commissions. As a result, 75 percent of sales managers don’t trust the information in Salesforce users want a system that is personalized, flexible, integrated, and that helps them close deals instead of requiring more work. Comments posted that have EHR counterparts include:

  • Salesforce wasn’t designed for the sales rep – it was designed to get information into a database so that work can be inspected and shared
  • Sales reps are like everyone else in avoiding the use of a system that provides them no personal value
  • Companies sell bots that can do some of the data entry work for users
  • Sales teams that use a defined process love Salesforce because it tells them what to do to close more deals, but reps who pride themselves on using their own methods hate it
  • Lack of Salesforce integration is often a problem with the implementation, not the platform
  • Companies use CRM as a tax on salespeople, a way to capture their information to make replacing them easier

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From Grand Padano: “Re: Athenahealth. Any plans to interview its new CEO? The chatter about what’s happening there post take-private is enormous.” I usually turn down interview requests from companies whose CEO is a new hire (thus giving us little to talk about except his or her optimistic plans) and has no healthcare experience (which Bob Segert does not). But I’ll consider it.

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From Junto: “Re: Epic on EHR-caused physician burnout. Judy is officially out of her depth if she thinks hiding behind loose research from KLAS is an appropriate response to physician burnout. It would be nice to hear from her how Epic can be part of the solution instead of deflected the EHR as a non-issue. It’s also beyond comical that KLAS, which makes an exponential percentage of revenue from EHR vendors, conveniently has research at hand for Judy saying EHRs are all that bad.” Epic CEO Judy Faulkner cites an upcoming KLAS report’s study as evidence that minimal correlation exists between EHR and physician burnout. The surveys came from KLAS’s Arch Collaborative, which benchmarks user experience survey results across its 150 paying members, which includes Epic (price ranges from a one-time $1,250 cost to $60,000 annual membership depending on organization size). As with most of KLAS’s research, the real question is their methodology – who they surveyed, how the questions were worded, who actually responded, and how well the results extend to other organizations. All that aside, my thoughts are:

  • I agree with Judy’s point that while doctors often don’t find their EHRs to be empowering and don’t enjoy the time required to feed the beast with their laboriously typed (or dictated) information, surveys don’t always tease out details about the software vs. the rules it enforces that someone else has saddled users with (the “someone else” being insurers, the federal government, and the frequent worst enemy of doctors – their employers).
  • Site-specific implementation issues are often involved, primarily setup, training, support, and ongoing communication about why the system works as it does.
  • EHRs may well have usability issues, but saying that EHRs specifically cause burnout (rather than being associated with it) is like saying that Word and Outlook burn us out when what we really hate is being overworked and underappreciated, being used short of our potential, being required to provide documentation that does not benefit us, and losing our idealistic view of our profession that turned out to be just another crappy job working for faceless overlords.
  • If Epic or another specific EHR were actually causing burnout, it would be reported by nearly every clinician user of those systems, and I haven’t seen that to be the case.
  • The VA’s VistA, one of the most antiquated and ugly systems ever built, has high user acceptance and minimal reported contribution to burnout because it has the luxury of focusing on what a doctor needs to deliver care rather than for billing, a situation that exists nearly nowhere else. It will be interesting to see how its replacement with Cerner, which was built around billing and administrative requirements, is perceived by those same doctors.
  • The argument that all EHRs cause burnout is also an argument that the software isn’t the problem. Those systems look and work wildly differently, with the only common ground being that they were chosen by organizations who wanted them to work in a certain way. I haven’t seen much evidence that doctors universally love any EHR despite the vendors of those system exploiting every competitive advantage they can find. It’s easy to hate the lawnmower when what you really hate is mowing the lawn.
  • EHR design and implementation decisions reflect what the decision-makers want and those aren’t the same people who actually use the EHR.
  • Burnout is not consistent across specialties even though many of them use the same EHR to varying degrees.
  • Working conditions often require doctors to complete their work after hours at home using the EHR, making it likely they won’t love it.
  • Asking Judy her opinion makes for great click-bait for dopey journalists looking for Twitter fodder, but doesn’t otherwise mean a whole lot. She doesn’t have to defend selling the market-leading product or to speak for the entire industry in explaining why the health systems that buy EHRs are somehow wrong.
  • The bottom line is that EHRs or not, physicians would be burned out because of the demands made by  those who pay them. All bets are off if you treat them like a monkey that gets fed only after dancing to organ music. Epic can’t fix that.

From Pointed Rejoinder: “Re: doctor empathy via robot. Not possible.” It may be unreasonable to expect skilled doctors, especially those such as surgeons and ED doctors whose services are one-and-done, to also be empathetic in a non-phony way to someone they don’t know. Still, nurses do it well all the time and I’ve seen some of our nastiest surgeons – feared and reviled for their tantrums and intentional hurtfulness toward hospital employees – behaving remarkably tenderly with a deceased patient’s family, which as a hospital employee always made me wonder if we really are incompetent, if the doctor was just using us as a punching bag proxy for our employer, or if they were simply putting on an act for their paying customers. Maybe hospitals should hire “empathists,” otherwise unemployable amateur actors who can pretend to be empathetic, letting them take the doctor’s handoff after delivering bad news in helping patients and families get through those first painful moments of understanding.


Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


Acquisitions, Funding, Business, and Stock

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Australia-based imaging software vendor Mach7 announces that it will implement a restructuring and cost-cutting program that it hopes will propel its US growth, firing its CEO and eliminating the CTO role in favor of strategic product management. The company has several high-profile US customers including Penn Medicine, UW Medicine, Brigham and Women’s, University of Virginia Health System, Adventist Health, Sentara, and Broward Health.

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Business Insider notes that companies such as Hims and Roman that send lifestyle prescriptions directly to the customer’s door often use TruePill, which aspires to the Amazon Web Services of mail-order pharmacy by offering itself as a B2B API and fulfillment service. The technology-focused company can send 100,000 orders per day and allows companies to control the patient experience in the form of custom packaging and shipping options. Co-founder Sid Viswanathan was also a co-founder of a business card scanning company acquired by LinkedIn, while CEO Imar Afridi was working as a CVS pharmacist two years ago.

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The Philadelphia paper questions whether Medicaid-heavy Temple Health — the closest thing to a public hospital in the country’s poorest large city — can survive competition from well-funded and growing competitors such as Penn and Jefferson. Temple is considering selling the cancer system it bought seven years ago, which is its most profitable business, to keep afloat. Temple has survived only because the state chips in a non-guaranteed $150 million per year, not only because the health system offers healthcare services, but because it employs many people.

Insurers Cambia Health Solutions and BCBS North Carolina sign a long-term management services agreement in which they will share corporate services and operate in five states under the Cambia Health Solutions name.


Sales

  • In Qatar, Alfardan Group and Chicago-based Northwestern Medicine select Allscripts Sunrise Ambulatory, Surgery, Radiology, Clinical Performance Management, Lab, and IPro Anesthesia for their joint project.
  • Chapters Health System (FL) will implement hospice and home health EHRs from WellSky.
  • DrFirst implements an interoperability gateway to provide medication histories to the Missouri Health Connection HIE.

People

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Carol Steltenkemp, MD, MBA, former board chair of HIMSS and the Kentucky EHealth Board, is promoted from CMIO to external chief medical officer of University of Kentucky HealthCare.

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Virta Health, which offers type 2 diabetes treatment via virtual health coaches and a ketogenic diet, hires Derek Newell, MPH, MBA as head of commercial. He was previously CEO of digital health benefits technology vendor Jiff and then president of its acquirer Castlight Health for 17 months.


Announcements and Implementations

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A new KLAS report on quality improvement software finds a near-revolt of users of the worst-performing Conduent and IBM Watson Health (the former Truven). The top-rated vendors for hospitals are Nuance and Quantros, while the ambulatory-focused vendor list is topped by Mingle Health, SPH Analytics, and Healthmonix.


Government and Politics

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HHS’s Office of Inspector General opens a position for Health Information Technology Attorney, looking for someone with expertise in EHR incentive payments, EHR interoperability, and breach notification to represent OIG in civil fraud enforcement and compliance with corporate integrity agreements. Do something wrong in health IT land and maybe you’ll get to meet the successful candidate.


Other

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ECRI Institute lists its top patient safety recommendations for 2019:

  1. Don’t rely solely on EHR information for diagnostic stewardship and test result management
  2. Manage patient expectations around antibiotics
  3. Review burnout and listen to provider concerns
  4. Deploy mobile health technology wisely by identifying patients who are good candidates, give them training, and monitor the systems for user error and inactivity
  5. Provide training and communication to ensure that all providers treat people who have behavioral health needs with dignity and respect
  6. Detect changes in a patient’s condition, including using alarms and other technology appropriately
  7. Use simulation training to maintain device and procedure skills
  8. Recognize the early signs of sepsis in all setting and develop protocols supported by tools for rapid response
  9. Increase awareness, surveillance, and reporting around peripheral intravenous catheter infections
  10. Standardize patient safety efforts across large systems and leverage the privilege and confidentiality benefits from forming a patient safety organization

An investment analyst thinks Apple will expand the Watch’s medical sensors and then sell the data of wearers to their doctors for $10 per patient per month, claiming that practices that provide services under risk-bearing contracts would be happy to give Apple a cut. I seriously doubt all of this, but mostly the idea that the Watch is collecting information that will allow doctors to deliver better, more cost-effective care to entire populations. 

America’s homeless population is fueling a resurgence of “medieval” diseases such as typhus, shigellosis, hepatitis A, and trench fever caused by living in unsanitary conditions.

A Health Affairs blog post questions whether CMS’s push to give people easier access to their medical provider-managed information will improve outcomes or improve smart shopping, when instead what is known to work is (a) making easily understood information available when they are making a decision; and (b) allowing them to share in any cost savings. The authors are encouraged by apps such as Apple HealthKit that help consumers understand their data and take action on it, but nobody really knows how they will be used.

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A man who threatened to sue MIT Technology Review for using his picture to accompany an article explaining why hipsters all look alike – he called it “click-bait” and “a tired cultural trope” — inadvertently proves the article’s conclusion when the editor-in-chief sends him a screen shot of the stock photo (which wasn’t of him) and concludes on Twitter, “All of which just proves the story we ran: Hipsters look so much alike that they can’t even tell themselves apart from each other.”


Sponsor Updates

  • Optimum Healthcare IT adds ERP to its service lines.
  • AdvancedMD and Aprima will exhibit at the AAOS conference March 12-16 in Las Vegas.
  • Arcadia will host Aggregate 2019 April 24-26 in Boston.
  • Artifact Health will exhibit at OHIMA 2019 Annual Meeting & Trade Show March 18-20 in Columbus, OH.
  • Avaya expands its line of video collaboration solutions with new offerings designed for smaller meeting spaces.
  • CompuGroup Medical will exhibit at the Arizona Medical Association Spring Conference March 16 in Phoenix.
  • Collective Medical releases a video featuring New Mexico Hospital Association Director of Policy Beth Landon.
  • Cumberland Consulting Group will exhibit at the Health Plan Alliance Spring Leadership Meeting March 19-22.
  • Diameter Health will exhibit at the Rise Nashville Summit March 17-19.

Blog Posts


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Morning Headlines 3/12/19

March 11, 2019 Headlines No Comments

Hill-Rom to acquire Voalte, Inc.

Hill-Rom will acquire Voalte for $180 million and integrate it into its care communications business.

House Veterans Affairs is Having Trouble Hiring Tech Experts

House Veterans Affairs Committee Chairman Mark Takano (D-CA) tells SXSW attendees that the VA is having trouble finding and retaining technology talent for its EHR modernization effort, citing the difficulty of finding candidates with the right mix of health IT experience and policy know-how with salary expectations that fit the VA’s budget.

Aetna Heads A $25 Million Investment Round Into MAP Health Management

Addiction recovery tech company Map Health Management raises $25 million in a Series A round led by Aetna.

Curbside Consult with Dr. Jayne 3/11/19

March 11, 2019 Dr. Jayne 6 Comments

My HIStalk team mates have already mentioned the sensational news item about a patient being told about a poor prognosis through telemedicine. It was a hot topic in both professional and personal circles this weekend, with reactions from outrage to understanding, so I wanted to weigh in.

Depending on which version of the story you read and who was writing it, the story ranged from “a robot told him he was going to die and they didn’t have any idea before that” to a much better explanation of what actually happened. I’ve seen the video clip, and although certain aspects of it aren’t ideal, it’s often challenging to have these kinds of conversations regardless of how they are held. Some of the challenges we face are unique to current attitudes in the US about technology, medical care, and death.

We’re so used to seeing miraculous recoveries on TV and in the media, whether fictional or not, that we’ve become detached to the realities of what can happen when you go into the hospital. For those of us on the inside, there’s less of a mystery. I’ve seen a healthy, 30-something physician roll onto the labor and delivery unit with her advance directive and healthcare power of attorney in hand, making sure that we understood her wishes because she knew what could happen. The nurses joked about it, but I knew she was serious. It’s not something the average expectant mother thinks about, but it’s a statistical reality, and some of us see the horrors that can happen every day.

I wish more people understood that the hospital is not an episode of “Grey’s Anatomy.” If you wind up in the intensive care unit, there’s a good chance you won’t make it out. And if you do improve, there’s a chance you might not be the same.

We are so focused on being able to do everything and overcome anything that we forget about the realities of age and that fact that you just can’t outrun the statistics no matter how hard you want to. A person of a certain age with underlying chronic conditions who goes into the hospital in respiratory distress has a significant chance of not going home. Our culture is so engrained in “battling” diseases and “the fight” that we push realities to the side. Physicians struggle with being the bearers of bad news, but we don’t do any service to our patients when we are overly optimistic.

For those on the receiving end of bad news, everything is colored by experience. If this is your first time experiencing the impending loss of a family member, you may receive it differently than someone who has been through it before. Whether you’re religious or spiritual and your own beliefs about death influence what you hear. It’s difficult for the care team to know where anyone is in this particular journey, especially with the fragmentation in healthcare today. Often the realities of today don’t include a patient being cared for by their family physician of 30 years at the bedside. There may be emergency physicians, a hospitalist, an intensivist, and multiple specialists. Maybe the patient has that family physician, but they’re hundreds of miles away from home when the unexpected happens. Maybe the patient has a nearby support system, maybe they don’t.

In the first half of the 1900s, people knew what death looked like in real life and they expected it. As an infant, my grandmother almost died of pertussis (whooping cough) and the neighbors who came to give their condolences were shocked that she was still alive. Families often cared for the sick at home and knew what was involved at the end.

In our high-tech age, we’ve medicalized the end of life so much that we forget it’s natural. Atul Gawande’s “Being Mortal: Medicine and What Matters in the End” is a great read in this regard. Different cultures have different feelings about end of life and I have enjoyed learning about different practices. In some communities, the process of dying is addressed with great self-awareness and attention to detail. It’s important for us in the healthcare trenches to remember that no matter how many times we’ve been involved in someone passing, there might not be an easy or obvious way to relate to every patient or family.

I’ve watched dozens of physicians have a similar conversation to what occurred on the video. Essentially, the physician is trying to talk to them about the level of care the patient is receiving and whether they want to focus more on comfort-focused care and symptom relief. Depending on the news account, some family members admit that they “knew this was coming and that he was very sick.” Another said they were just learning that he was gravely ill. One objection was to the technology itself, including the volume of the speaker and its proximity to the patient who had difficulty hearing.

We don’t know the full extent of the situation, whether the family had experience with a video-based consult before, or how the telehealth process was explained to them. We can’t see who else is in the room or at the bedside, but it’s easy for many to pass judgment on it. Even in person there are difficult conversations around this topic, where physicians struggle to find the balance between recommending care that can help and care that might hurt. Families struggle with feelings of giving up versus fighting for life.

This situation creates a tremendous opportunity to have conversations around technology on both professional and personal levels. As someone in healthcare, how did this story make you feel? How does it relate to what your institution might be doing? Are there ways you could be doing things better or otherwise differently? On a personal level, have you talked with family members about their wishes should something happen, whether expected or unexpected? How would you react if a loved one was being cared for by virtual members of the team? How do members of the family value quality vs. quantity of life and how do those beliefs influence medical care choices?

We always talk about assuming positive intent and I don’t think anyone involved in this video consult program intended for a family to be hurt or upset. Sometimes things occur that are out of our control or sometimes mistakes are made, and we can use those experiences to change how we approach things in the future. As “insiders,” we can help educate our families and friends about the realities of what we see day in and day out and how it’s not at all like you see on TV or in the movies. We can start a discussion that will perhaps lead to other conversations that might make it easier on some other family down the line. We can learn about other approaches to death, dying, and intensive medical care and decide whether we want to think about situations in new ways.

As a society, let’s temper our outrage and figure out how we want to do things better.

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HIStalk Interviews Guillaume de Zwirek, CEO, Well Health

March 11, 2019 Interviews No Comments

Guillaume de Zwirek is founder and CEO of Well Health of Santa Barbara, CA.

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Tell me about yourself and the company.

I founded Well almost precisely four years ago. My background is not in healthcare. I started my career as a classical musician. Then I worked at Google for four years, then afterward at a big data company that we sold to Amazon. I started a healthcare company because I found myself in a hospital one day and I was just so frustrated with my experience.

Well helps patients and administrators break free of antiquated communication practices. We provide a single command center that connects the many tools they use, transforming everyday interactions between patients and providers.

How can we be sure that hospitals will think about what the patient needs and wants instead of just blasting out self-serving, generic messages that focus on whatever benefits the health system’s bottom line?

I founded this company because I was disturbed by the amount of robo-spam that existed in healthcare. When I was at Google, I saw a transformation from web to mobile apps and then from mobile apps to messaging. That was happening right around the time I was leaving. 

My experience in healthcare in 2015 was precisely what you are describing. Getting four to 17 messages, all saying the same thing that I can’t respond to, with no human on the other end. My only recourse is to call and wait on hold for 17 minutes. That to me is not customer service.

This is an industry that takes up the vast majority of GDP. On average, Americans spend $11,000 a year on their healthcare. A lot of that goes to insurance companies, but you would expect a bare minimum level of support in that environment. One thing I love to tell my team is, pick your favorite retailer — Nordstrom, Lululemon, you name it. Imagine if they were guaranteed $11,000 for every customer that walked in their door. What would they do? How would they treat their customer?

That’s how I like to think about healthcare, because I’m not from this industry. This is my first time in this industry. I encourage healthcare systems to think bigger and to go beyond the status quo. In an era where everyone is talking about AI, machine learning, and automation, we’ve gone in with a totally different approach. You have a phenomenal staff of people at your health system today. They just need the tools to be able to speak to your customers more effectively and make them feel human. It’s really concierge care, but in a way that is much more efficient for both parties involved.

My experience is that providers like to put up self-serving technology walls as a scalable alternative to paying humans to be available, so that if they can make money sending out robo appointment reminders to the potentially unruly masses without hiring people, that’s all they will do. How do you sell them on the idea that it’s OK to allow customers to speak with an actual human?

The problem is that the tools and techniques that are being used today aren’t effective. Look at the portal’s adoption rate across the industry. It’s abysmal. Ask every leading healthcare IT company about their numbers and what engagement looks like with patients. It’s not pretty.

When I was working at Google, my success and failure metric was, will a billion people use this? I was thinking about things on a different scale. I would have gotten fired for having 10 percent of people engaging with a release that I made. That to me is the framework that healthcare should be thinking about when they’re thinking about technology. 

The reality is that you’re only going to engage people when you treat them the way they want to be treated. For texting especially and for messaging, I was seeing a very disturbing pattern. I didn’t want texting to become the new email.

For me, that meant putting humans behind the scenes. An even more important piece was connecting all the pieces. I’m going to divert from your question a little bit, but I’d like to speak to a trend that happened 15 years ago with the EMR and the EHR. This concept where health systems had bought a lot of best-of-breed technologies and all the data was sitting in different silos. The EMR comes around and all the data comes together in one place. Obviously the government fueled this, but there was a deliberate effort by health systems to piece everything together into a central database. Epic and a bunch of others did a great job here.

When I talk to health system executives, I give the same pitch for communications. We’re in a period in time where customer loyalty, customer retention, and building a long-term relationship with patients are critically important. You will never be able to do that if you have 100, 200, 500 different healthcare IT vendors that are all trying to communicate with your patient independently.

I was talking to a health system executive three weeks ago who told me she has 1,000 vendors. One thousand. She did a journey map of her patients, and there was a situation where a patient can get 17 appointment reminders coming from different systems. That’s because the systems aren’t playing nice together.

A big part of this is the educational piece. My pitch to health systems execs is think about communications the same way you thought about data 10 or 15 years ago. Everything needs to be routed centrally. You need to have live agents on the other side to help patients when there’s a need for service recovery.

Health systems like the idea of patient engagement even if they don’t fully understand or embrace what it means. Are they talking to patients about what they want and how they want to receive it?

I’m encouraged by the fact that over the past few years, this position of chief patient experience officer or patient access has become pretty prevalent across health systems. I’m encouraged by the fact that health systems are hiring leaders from outside of healthcare.

Product design and customer research in healthcare is probably lagging behind other industries. A lot of that has to do with the fact that healthcare has acted a lot like a monopoly over time. It’s hyper-local. There might be only a few health systems. The insurance companies control the patients, where you go wherever your insurance company pays. A lot that is changing as patients pay more money out of pocket.

But healthcare for the longest time has had the makeup of a monopoly, just like cable companies and the government. Which is why when you look at customer service ranked by every industry, those are the three worst. They all have monopolistic tendencies.

As someone coming into healthcare from the outside, did it surprise you that unlike in nearly all other industries,  we can’t really define who our customer is?

I’m fortunate that I wasn’t from healthcare and came to the industry with open eyes. I’ve learned a lot. Healthcare is complicated, and for good reasons. There are nuances with patients. A mother with three chronic conditions in a rural area is going be very different than a high-tech Silicon Valley yuppie. There’s a lot of merit to healthcare being more complicated. It is a really, really hard challenge. 

We’re still in the early days of figuring out what a patient engagement strategy means. Health systems are thinking through individual problems. Let me tackle scheduling and registration, eligibility, or telemedicine. We should be taking a step back and thinking about how we can help patients of all these different backgrounds navigate their unique patient journeys. That’s where it comes back to communications for me. That’s where I’ve been laser focused over the past four years.

Is it difficult to get that rational argument heard above all the noise that tends to buzz around healthcare IT?

That’s one part of it that is sad. The most effective way we’ve found to sell is come in and rip and replace legacy systems, the robo-dialers and robo-spammers that every health system has today that send out those appointment reminders that patients love to hate. Then, hopefully, to use that as our Trojan horse to start developing a strategic relationship with the executives and help them understand how they can map out the end-to-end journey, put agents behind this, and offer an unparalleled experience. But that’s the hard part. It’s unfortunate that that’s the way in.

But I’m also pragmatic. I realize that this is a complicated industry with a lot of competing initiatives. Every health system is doing a double Epic upgrade and and CMS is changing their rules left and right. I understand the nuances and the complexities. It was definitely a surprise for me, and one of the sadder things for me, that we have to start there and I can’t start with the full package. I can’t start by implementing this comprehensive, end-to-end solution that would change the way patients experience healthcare. 

It’s baby steps. The jury is out over the next two to three years whether we can get people from that better robo-dialer experience to a truly integrated communications journey for patients.

In the absence of a chief experience officer or chief patient officer, who makes your case internally?

It depends on the health system and where the pain is felt the most. Sometimes it’s IT that is so frustrated with the way that their systems run today. In our world, it’s batch files at night that sometimes go wrong. Patients get the wrong messages and they end up filing support tickets and waiting three weeks. That is when IT feels a lot of pain.

Sometimes it is operations. You’ve acquired health systems, brought on new doctors, exited doctors, and you’re having to manage this entire operational side that is just becoming too time-intensive with existing technologies. That is typically where we are selling.

What is more interesting to me as we move towards risk is thinking about how we could potentially sell on the financial side, to the CFO, to the CMO, to the CNIO. People who realize that keeping patients out of the ED, keeping patients healthy, keeping patients adhering to the protocols that they want them to has long-term impact on their bottom line. That’s where I’d like to see things go. The message will resonate more. But we are still trying to figure out how to sell our message to that group.

How should a startup work with an accelerator or incubator?

You have to go in with a clear goal and objective. We went through an accelerator that was done in partnership with Techstars and Cedar-Sinai. When we accepted the offer to join that accelerator, our goal was to rip and replace their legacy reminder vendor. That was my only goal, my team’s only goal, for the four months that we were there.

We knew that if we succeeded, it would have been worth every minute we spent there. If we failed, we would have learned a lot about how to sell into healthcare, large health systems, and the nuances of workflow. We were successful, but even if we hadn’t been and we had learned those lessons, it would have been time well spent and we wouldn’t have been stuck in this endless pilot phase. I recommend not doing free pilots.

When it comes to accelerators with health systems, I’ve been disappointed to see some of the new accelerators that have come out that try to charge startups money to join. It’s so hard to start a company and be an entrepreneur, especially a first-time entrepreneur like myself, and if we’re going to encourage innovation in healthcare, we need to encourage companies to come to our health systems and spend time with us. We should pay startups if we can. If we want a pilot of their technology, we should pay them, because it costs a startup money to get something running.

The most important thing is that they learn, and they learn quickly, is that the killer of all innovation is time. You can’t buy time. You can’t make time. You have to move as quickly as possible.

We say in health system IT that nobody in the organization is empowered to say yes, but everyone is empowered to say no. Do you find that you need someone to go to bat for you?

It is better to get a quick no than a maybe. I learned this in raising venture capital money. I’ve raised over $14 million and I learned this lesson the hard way many many times. It is way, way better to get a no than it is to wait for months and months and months for a maybe.

The way we did it specifically when we went through the accelerator is that I just asked for meetings. I had a list of 56 practice administrators who had some sort of decision-making authority over the system they had in place. People are normally happy to introduce you to other individuals, especially entrepreneurs and people who are trying to introduce innovative technology. I went into those 56 meetings with an open mind, but a very very clear goal. I got great feedback and refined my pitch, and at the end of the day, I had 50 people who said, I would pay you for this. 

I went to the CIO of this health system and said, I’ve got a bunch of contracts. I think you owe me a few million dollars. What do you think? And I got three pilots out of that. They paid me for the pilots, which was fantastic. But getting to no is sometimes a much harder feat than getting to yes, and it’s just as important.

Silicon Valley types often think they know everything and roll their eyes at any industry that they think is not using technology optimally. How did you develop an ability to avoid talking down to healthcare people in a way that would have made them less likely to want to work with you?

I had my foot in my mouth a few months into starting this company. I was trying to get into this accelerator and they thought we were blowing smoke around integration. I had never integrated before. It sounded really easy. I talked a really strong game around integration. They gave me a second chance to come in and have some humility, be honest about what we knew and what we didn’t know, and where we needed help. I’ve carried that lesson with me every single day since that experience, and that was almost three years ago.

At the core, what keeps me honest is that I’m a patient. All I want is to make things better. I want going to the doctor to be as easy as meeting up with a friend for coffee. I recognize that there is way more complexity than patients ever realize. If I can seek to understand that complexity and partner with health systems to figure out the right solution to making that seam invisible and frictionless to patients, then that’s a win. It doesn’t matter how long it takes. I just need to find the right partners who are willing to get creative and co-develop with us.

That’s where I’m having some of the most fun. Learning with health systems, understanding the challenges, getting curious, and at the end of the day, just trying to make the experience of healthcare something that’s as enjoyable as calling an Uber.

What are the most relevant lessons you learned while working for Google?

There are two lessons that came from the company after Google. I was at a company called Graphiq that now powers a lot of the technology behind Amazon Alexa. The founder there is Kevin O’Connor, a serial entrepreneur. He founded a company called DoubleClick that runs most of the display advertisements on the Internet. 

I learned two concepts from him that I’ve carried with the company. The first is the concept of test-fail-learn, test-fail-learn, test-fail-learn, test-succeed, and then scale the crap out of the things that work. We do a lot of testing. We are very, very focused on analytics. We want data from our customers. We want to give them the data we have. When things aren’t working, we want to pivot.

I’ll give you an example. Early on, we thought that we could launch a health system-to-patient communication solution and also launch a clinician messaging solution at the same time. We failed miserably. I realized within two days of launching a solution that that was such a hard and complicated problem that there needs to be companies dedicated to that solution. Companies like Vocera and TigerConnect do that. That’s just one example of me learning and the test-fail-learn, test-fail-learn mantra.

The other one is this concept of scalable opportunities. Looking at the market, thinking about the things that really excite us but that we don’t really know how to solve yet, and assigning people to those initiatives just so that they become experts in them. As we figure out ways that we might be able to plug into these trends, testing solutions. For us, those are things like the payer landscape and value-based care. There are seven other items that sit on our whiteboard that no one’s actively working on, but we have one person on the team dedicated to thinking about them. One day they might find their way into our product and into our solution. But they are very much pie-in-the-sky ideas, scalable opportunities that we might choose to introduce to our company one day.

As a healthcare newcomer, what did you think of the HIMSS conference?

There was a lot going on. My heart goes out to anybody making purchasing decisions in healthcare. There are so many choices, there is so much noise, there is a lot to make sense of. In my opinion, it doesn’t look like there are clear winners in any category. Walking the, whatever it is, one mile or two miles of the exhibit floor is a clear example of that.

We knew that we had to have a decent presence at HIMSS for people to take us seriously. We went to HIMSS with two goals, to build vendor relationships and to meet with our existing clients and to meet with prospective clients while they’re all under one roof. I was happy with our performance and being able to achieve those goals, but it is a noisy space. I don’t have any solutions around how to make sense of the noise. I guess as a vendor, trying to be louder and trying to prove more value in a way that people hear who are making those buying decisions.

Do you have any final thoughts?

I’m having more fun than I have ever had in my career, and I’m 12 years into my career. I’m sure you’ve heard this from people many times in the years you’ve been writing HIStalk, but I believe that we are at a juncture in healthcare. I believe that patients feel empowered. I am encouraged by many of the new companies coming into healthcare. I am so encouraged by health systems that are opening up their doors to companies like ours, to help them learn and to help them bring new technologies to market. I am hopeful that investors will continue putting money into healthcare IT and that they will see big successes that keep fueling development in healthcare. 

At the end of the day, my personal goal is to flip the status quo, in which healthcare is in the bottom three industries in terms of customer service. In my humble opinion, it should be number one.

We have a long journey ahead, but there’s a lot to be encouraged by and excited about. It’s people like you, investors, health systems, and frankly, companies coming into the space and even competitors of ours. So I really thank you for taking the time to speak with me and for seeking me out. It’s people like you who are helping drive this industry forward the ways it needs to be driven forward. I’m very appreciative.

Morning Headlines 3/11/19

March 10, 2019 Headlines No Comments

Hidden FDA Reports Detail Harm Caused By Scores Of Medical Devices

FDA has given surgical stapler manufacturers an exemption from publicly reporting problems to its MAUDE database of medical device failures, allowing them to hide widespread problems.

Spokane’s Columbia Surgical Specialists paid nearly $15,000 in a ransomware attack that compromised patient data

Columbia Surgical Specialists (WA) pays $15,000 to regain access to its data following a ransomware attack.

Doctor tells patient he doesn’t have long to live through hospital robot’s video screen

Kaiser Permanente apologizes for one of its doctors telling a 79-year-old inpatient that he was dying via a telemedicine robot.

VA and DOD set to pick health data decider

DoD and VA officials expect to have a lead for their joint EHR efforts named within the next two weeks.

Monday Morning Update 3/11/19

March 10, 2019 News No Comments

Top News

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FDA has given the manufacturers of surgical staplers an exemption from publicly reporting problems to its MAUDE database of medical device failures, allowing them to hide widespread problems by submitting just 100 incidents in 2016 vs. the 10,000 that were actually reported.

FDA’s alternate summary reporting program – created to save FDA employee processing time — allows manufacturers to send a quarterly or annual spreadsheet list of problems instead of detailed reports.

Several experts, including former FDA Commissioner Rob Califf, said they’ve never heard of the program. Companies that use the option tend to keep quiet about it to prevent competitors or prescribers from finding out the true patient impact.

Among the non-reporters are manufacturers of pelvic mesh, the da Vinci surgical robot, and several critical heart devices.

FDA responded to the Kaiser Health News report by saying it will analyze the summary reports, also adding it will make public the 41,000 safety reports it has received that involved surgical staplers. Those reports included 366 deaths, 9,000 serious injuries, and 32,000 malfunctions.

It’s puzzling that FDA received so many patient safety incident reports that it decided its best action was to stop requiring them.


HIStalk Announcements and Requests

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Around half of poll respondents say the federal government’s role in interoperability should be to set technical standards, while the distant #2 choice is for the federal government to stay out of it entirely and let the market figure it out.

New poll to your right or here: for provider employees, how much time and energy does your employer devote to planning or delivering value-based care?


Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


Sales

  • Medway NHS Foundation Trust joins TriNetX’s global health research network to attract more clinical trials and to support research collaboration.

Decisions

  • Firelands Regional Medical Center (OH) replaced Aris Radiology with REAL Radiology For teleradiology in fall 2018.
  • Braxton County Memorial Hospital (WV) will Implement Epic in June 2019.

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


Privacy and Security

Columbia Surgical Specialists (WA) pays $15,000 to regain access to its data following a ransomware attack, explaining, “We received notice from the people that encrypted the files just a few hours before several patients were scheduled for surgeries, and they made it clear we would not have access to patient information until we paid a fee.”


Other

Kaiser Permanente apologizes for one of its doctors telling a 79-year-old inpatient that he is dying via a telemedicine robot. The family says it was hard to hear what the doctor was saying due to the robot’s small speaker, but it was clear when he said, “I don’t know if he’s going to get home” due to the patient’s failing lungs. The man’s daughter recorded the incident on video thinking the family would be receiving care instructions. The patient died two days later. It sounds harsh, but I’m not so sure – not all telemedicine visits will result in good news, the provider isn’t necessarily geographically accessible to the patient, and the idea that empathy requires physical presence may need to be challenged. Or perhaps it’s unreasonable to expect skilled clinicians to be good at comforting patients or consoling their families as much as we as patients would like it. There’s probably no good way to be told – accurately, as it turns out – that you are dying.

23andMe will add type 2 diabetes risk factors to its consumer genetic screening once FDA approves the test, although the science behind it is shaky (it looks at a package of existing genetic traits rather than a specific genetic abnormality and it is known to be super inaccurate for black Americans, for example) and it has not been reviewed in the medical literature. My questions:

  • How many people already have known diabetic risk factors, what are they doing about it, and how does this new test benefit anyone other than 23andMe?
  • A big percentage of people have known diabetic risk and it’s not clear how many of them take action that are proven effective to avoid moving to active diabetes. What would patients do differently from the results of this test? How does this test change outcomes?
  • What is the immediate course of action for someone who tests positive? Call their PCP for an immediate appointment and then be identified for life as “prediabetic” and run up bills for drugs and monitoring? Who’s going to pay? How many of those patients have already been told by their PCP that they are at risk but haven’t done anything?
  • Is 23andMe motivated more by its partner agreements that allow those who are identified as being at risk to sign up for paid coaching programs?
  • As one expert says, “You might as well just look in a mirror. That’s as good a predictor for diabetes as all your genes put together.”
  • Every medical student is taught that you don’t measure something just because you can — the course of action is uncertain; chasing a lab result isn’t necessarily beneficial to the patient; medicalizing a symptom-free patient often doesn’t make sense;  and plenty of people already have diabetes but don’t receive treatment.
  • The odds that this test will move the US public health needle is just about zero despite our widespread (and profitable) misperception that we just need to diagnose more stuff.

Sponsor Updates

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  • US Air Force Reservist Senior Master Sergeant Andrew Branning, director of CloudWave’s project management office and quality and recently returned from overseas deployment, nominates his supervisor Mark Middleton, VP of cloud services and chief quality officer, for the Patriot Award. The award, overseen by the DoD’s Employer Support of the Guard and Reserve, allows citizen soldiers to recognize the supervisors who support their work by offering flexible schedules, time off before and after deployment, and family care.
  • Seven hospitals in Mississippi and Alabama form the Mississippi Meditech CIO Collaborative to share common goals, challenges, and a dedication to improving healthcare with EHR technologies.
  • Medhost enables integration of National Decision Support Co.’s CareSelect Imaging with its EHR.
  • NextGate will exhibit at State Health IT Connect Summit March 18-20 in Baltimore.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Virginia Section Conference March 17-18 in Charlottesville.
  • FlyWire’s global payment and receivables business accelerates into 2019 after integrating OnPlan Health.
  • Experian Health will exhibit at the Semi-Annual ACO Leadership Forum March 11-12 in Chicago.
  • Sansoro Health releases a new podcast, “The Power of Patient & Family Engagement.”
  • Vocera will exhibit at the NYONEL Annual Meeting & Leadership Conference March 17 in Tarrytown.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 3/8/19

March 8, 2019 Weekender No Comments

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Weekly News Recap

  • Livongo’s planned Q3 IPO could bring in $1 billion
  • Carestream Health sells its health IT business to Philips
  • Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett
  • Amazon, Berkshire Hathaway, and JPMorgan Chase name their healthcare venture Haven
  • FDA Commissioner and digital health advocate Scott Gottlieb, MD resigns
  • Newly formed Beth Israel Lahey Health says it will eventually consolidate its multiple EHRs into a single product

Best Reader Comments

There is no long road to interoperability. There are data solutions right now that can curate and harmonize all the data that’s out there. FHIR is not going to be a magic bullet either. Healthcare organizations have to stop waiting for Judy to figure it out and invest in an enterprise data strategy and platform. (BK)

A single-payer system that rams real metrics down our throats will engage value-based care as a viable alternative. The original Obamacare bill had a subscription-based expansion of Medicare, i.e. a 25-year-old could pay premiums directly to Medicare for enrollment. Medicare would effectively be setting the floor for premium costs, and commercials would have to come down and offer better services to compete. This absolutely is the way we are trending and will happen at some point. The question is when, and will the healthcare systems/HIT be ready to change to really win the business of patients with VBC. (SinglePayor)

I shouldn’t be, but I am surprised how often I see vendors and providers hyping up value-based care. Upside only arrangements don’t count. Payments based on weak quality metrics aren’t important to consumers. Prices aren’t available to consumers. Where is the value? Most hospitals and health systems have about 5 percent of payments tied to VBC. My opinion is that the only providers who can claim VBC: true IDNs and those that offer a significant number of bundles (Geisinger’s proven care model). If you talk to hospital CEOs and CFOs, it’s very rare to find VBC in their top 10 priorities. My sense is that vendors are driving the hype. (Desperado)


Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. D in Massachusetts, who asked for classroom speakers for her elementary school class. She reports, “These speakers have been a lifesaver for my classroom. I use them for all my lessons and for brain breaks for my Littles. For math warm-ups, we often watch videos that help my students learn to count to 100 by 1s, 2s, 5s, and 10s. In reading, I was able to find audio and videos on books that we are reading in the classroom. During indoor recess, I often put on videos of different habitats and they love to just sit on the carpet, listen, and see different worlds. The girls love the speakers on Just Dance Friday, where if the class has earned enough reward points, we turn the classroom into a dance floor. Thank you for the donation to my classroom.”

Median monthly rent for a one-bedroom apartment in San Francisco has risen nine percent in the past year to $3,690. That’s before the upcoming flood of tech IPOs creates thousands of new company millionaires who are anxious to kick off their conspicuous consumption by buying houses, throwing lavish parties, and buying boats even as financial planners warn them that their counterparts at Groupon and Snap did the same until their shares went down in flames. A real estate analytics expert predicts that one-bedroom condos will be worth at least $1 million in five years and single-family homes will average $5 million.

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Company swag at Livongo’s first user group meeting included a day’s use of partner company’s continuous glucose monitor patch, reminding everyone about just how big a business diabetes (or the threat of it) is in the US as Livongo barrels toward its $1 billion IPO.

The mainstream press notices that the proposed HHS interoperability rule would also require hospitals to publish the actual prices they have negotiated with insurers. You needn’t wonder where the AHA stands on this issue.

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The hospital gown that Kurt Cobain wore in Nirvana’s headlining set in Reading Festival 1992 has been put up for auction by a fan who says Courtney Love gave it to him during a vigil after Cobain’s suicide in 1994. Cobain was pushed onto the stage in a wheelchair while wearing the gown, sang a few lyrics from Bette Midler’s “The Rose,” and then pretended to collapse before springing up to rip through a 25-song set whose bootleg is prized by collectors as one of the band’s best, all to dispel rumors that he wouldn’t make the show because of his drug addiction.

A six-year-old boy whose parents refused to have him vaccinated becomes Oregon’s first pediatric tetanus case in 30 years, with his family refusing to continue the vaccine series that was started during his 57-day hospital stay that cost $800,000.

The parents of a 21-year-old who died in a skiing accident hire a lawyer to force Westchester Medical Center (NY) to save a sample of his sperm with the hope of “preserving some piece of our child that might live on,” but the court will have to decide what happens to the sample since the son didn’t give his permission. He was the only child of the couple, who is from China, and that country’s previous one-child policy has resulted in his having no male cousins to carry on the family lineage. Ethicists say that policies and laws aren’t consistent and there’s the question of who would choose the egg donor and raise the child.

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Pop-up, spa-like stores are offering to freeze the eggs of women who worry about the ticking of their biological clocks, hosting champagne parties to convince prospects to pay $5,000 for the procedure and the first year of freezer time. One chain features Dr. Oz on its board, reassuring patients that their medical care will be overseen by someone who has won seven Daytime Emmy Awards.


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Morning Headlines 3/8/19

March 7, 2019 Headlines No Comments

Digital-Health Startup Livongo Eyes 2019 IPO

Chronic disease management-focused digital health company Livongo hires underwriters to prepare a Q3 IPO that’s expected to bring in $1 billion.

Carestream Health To Sell its Healthcare IT Business To Philips

Philips acquires Carestream Health’s imaging IT business for an unspecified amount.

Audit: Bad billing system costs Glens Falls Hospital $38 million in revenue

Auditors blame a 2017 implementation of Cerner’s billing system for the $38 million revenue loss of Glen Falls Hospital in New York.

Dozens Of Northwestern Hospital Workers May Have Been Fired For Improperly Reviewing Jussie Smollett’s Records

Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett, who was treated in its ED following his claim of being attacked in a racially motivated incident.

News 3/8/19

March 7, 2019 News 2 Comments

Top News

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Amazon, Berkshire Hathaway, and JPMorgan Chase decide to call their healthcare venture Haven.

The bare-bones website launched along with the brand is light on concrete details about the company’s plans, though visitors can glean a few details about its goals and structure if they dig deeply enough:

  • Haven will focus on offering employees of the founding companies easier access to primary care, easier-to-understand health insurance, and affordable medications.
  • It will use data and technology in unspecified ways to meet those goals.
  • Haven seeks to become an ally of rather than a competitor to healthcare stakeholders.
  • Profits will be reinvested.
  • It may one day share its solutions with other interested parties.

Of its nine-member team, only CEO Atul Gawande, MD and Head of Communications Brooke Thurston have health system experience. CTO Serkan Kutan comes from Zocdoc, Head of Measurement Dana Safran from BCBS, and COO Jack Stoddard and Chief of Staff Megan McLean from Comcast.


Reader Comments

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From La Vida Loca: “Re: [company CEO name omitted]. Have you seen his arrest record?If I were on the board, which he controls, I would be investigating moral turpitude as a cause. What does that do to the business?” I hadn’t heard that, but Googling turns up a September 2018 arrest and his co-founder wife has since left the company. I’m not naming him because I don’t see that he ever went to trial.

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From Cranapple: “Re: CareTrac HIE. Reading between the lines, it is folding because the big Epic hospitals in Minnesota won’t share data.” The forwarded announcement from Southern Prairie Community Care says the HIE doesn’t have a business case because large health systems won’t share their data, adding that HIE’s technology vendor Change Healthcare won’t devote the resources to connecting the HIE to the EHealth Exchange (which the state requires of HIOs) that would have given the smaller players at least some big-hospital data.

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From Amy Gleason: “Re: healthcare costs. Check out what my daughter wrote about her monthly infusions. Her newest insurance pays $202K per year more than the last insurance. She is horrified and doesn’t understand why there isn’t an app that would help her.” First off, Amy has moved on from the shuttered CareSync and is now working for the White House’s US Digital Service on HHS/CMS interoperability projects. Her daughter Morgan’s write-up describes the situation – she gets the same infusion every month from the same doctor, same hospital, and same nurses, but the three insurers that have covered her have paid wildly different prices. Like normal humans, she’s wondering exactly how forcing hospitals to publish their chargemasters accomplishes anything when the healthcare world revolves around confidential discounting with each insurance company. I wish I had something encouraging to say, but Morgan has already wisely concluded that “I am thinking that we might really need to just burn the healthcare system to the ground and completely start over,” although I won’t burst her bubble by mentioning that fire trucks – in the form of politicians who are well paid by the profitable status quo – always manage to squelch those flames.

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From Odd Bedfellows: “Re: Molina Healthcare. Offering its Washington State Medicaid members a free 90-day subscription to Amazon Prime.” There’s so much wrong here that I don’t know where to start, so I’ll save my snarkiness for this – even after the free subscription ends, the Medicaid members pay just $5.99 per month and that’s a lot less than I pay. You folks in Washington are generous to provide your less-fortunate neighbors with two-day delivery and Prime Video streaming while you’re off working. Still, I’ll table my cynicism temporarily in noting that for those who have transportation issues and who live in food desert neighborhoods, Prime could indirectly improve health and lower costs and I assume that Amazon is footing some or most of the cost in its attempt to get every American on Prime (and 100 million of us have already signed up).


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Artifact Health. The Boulder, CO-based company made headlines this week for its just-announced work with AHIMA to deliver compliant physician query templates (documentation clarification) via its cloud-based platform. Health systems using Artifact reduced their AR days by increasing response rates to nearly 100 percent and reducing average response time by 80 percent. Doctors can respond from their computers or smartphones (often in just three taps) and appreciate receiving the same format for all queries (CDI, inpatient, outpatient, and pro fee). Their responses are recorded directly in Cerner, Epic, or Meditech to become part of the legal medical record with no manual recordkeeping by CDI specialists and coders. Thanks to Artifact Health for supporting HIStalk.

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I decided to leave my HIMSS19 burner phone active for a bit longer, just in case you want to text me something interesting.

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I’ve received a few reader inquiries lately about not getting my email updates because of spam-blocking or other email filtering on their end. Sign up again if you are among them – you only need to enter your email address and there’s no risk otherwise.


Webinars

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


Acquisitions, Funding, Business, and Stock

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Long-term and post-acute care software vendor PointClickCare acquires LTPAC-focused medication management company QuickMar.

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Chronic disease management-focused digital health company Livongo hires underwriters to prepare a Q3 IPO that’s expected to bring in $1 billion. The company has raised $240 million since former Allscripts CEO Glen Tullman started it in 2014.

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Philips acquires Carestream Health’s imaging IT solutions business – which includes VNA, diagnostic and enterprise viewers, and clinical, operational, and analytics tools — for an unspecified amount.


People

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Impact Advisors hires Jay Backstrom (Schumacher Clinical Partners) to lead its newly expanded telehealth consulting service.

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Apixio hires Jennifer Pereur (Hill Physicians Medical Group) as VP of solutions and Terry Ward (Change Healthcare) as SVP of solutions.


Sales

  • Allina Health (MN) selects patient engagement software from PatientWisdom.
  • In Texas, Arise Austin Medical Center and The Hospital at Westlake Medical Center will adopt Allscripts Sunrise.
  • The Escambia County Healthcare Authority in Alabama will implement Cerner Millenium at D.W. McMillan Memorial Hospital, Atmore Community Hospital, and four clinics. Atmore appears to be running Epic under Infirmary Health. The hospitals will also run Cerner RCM, ancillary, and ambulatory as well as outsource its business office to Cerner.
  • The University of Kansas Health System chooses Connexient’s MediNav digital wayfinding software.
  • WakeMed Health & Hospitals (NC) selects PeraHealth’s Rothman Index predictive analytics.

Government and Politics

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VA officials tell members of a House appropriations committee that it will roll out its new Cerner EHR at three facilities in the Pacific Northwest early next year. John Windom, head of the VA’s EHR modernization effort, told lawmakers the pilot had been slowed down to give end users more training time. Also on the VA’s to-do list: finish converting VistA data into a Cerner-friendly format for migration, getting a permanent deputy secretary installed to oversee the roll out, and ensuring VA providers have security clearance to access DoD health records.

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This op-ed lays part of the blame for the spectacular rise and self-destructive fall of Theranos at the feet of the US Patent and Trademark Office, which it says has done “a terrible job” of ensuring that whether inventions actually work. The office has admitted to operating on an honor code, a system that worked well for founder Elizabeth Holmes:

Yet more than a decade after Holmes’ first patent application, Theranos had still not managed to build a reliable blood-testing device. By then the USPTO had granted it hundreds of patents. Holmes had been constructing a fantasy world from the minute she started writing her first application, and the agency was perfectly happy to play along.


Privacy and Security

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Northwestern Memorial Hospital fires dozens of employees for looking at the EHR records of actor Jussie Smollett, who was treated in its ED following his claim of being attacked in a racially motivated incident. One terminated nurse says that she and co-workers were fired for simply scrolling past the actor’s name on an EHR list while looking for other patients. The real crime in this story is that a grown man named Justin thinks Jussie sounds better.

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Medical billing vendor Wolverine Solutions Group notifies hundreds of thousands of patients from an undisclosed number of providers and health plans of a ransomware attack that occurred last September. The company has been sending out notifications on a rolling basis since December, and expects to wrap up messaging by the end of this month, at which point it will have a better idea of how many people were affected.


Other

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Auditors blame a 2017 implementation of Cerner’s billing system for the $38 million revenue loss of Glen Falls Hospital (NY), which was forced to lay off employees after losing 12 percent of its annual patient services revenue due to bills that went out late or were never sent.  

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A brilliant article in Science looks at how the public relations chief of the American Diabetes Association came up with the term “prediabetes” in trying to scare doctors and their patients to take action to address slightly elevated blood glucose levels, a mostly benign, symptom-free condition that had previously been labeled “impaired glucose tolerance.” ADA rolled out the term on a wide scale and keeps broadening the definition to include more people, now counting one in three Americans as being prediabetic even though studies show that only single-digit percentages of them will ever have diabetes. Since then, billions of dollars have been spent to address the observed blood glucose levels – mostly weight loss and exercise programs that have shown few results – and the now-medicalized “condition” has created a cottage industry of fitness coaches, dietary products, glucose monitors, and prescription drugs that now consume at least $44 billion of US healthcare spending each year and line the coffers of the ADA with up to $27 million annually in drug company contributions. A researcher who advocates wider use of prescription drugs to treat prediabetes has earned $5 million from the companies that sell those drugs and many doctors who wrote the ADA’s standards of care have also made millions. A Mayo diabetes clinician concludes, “The people who lose are the people who go from being a healthy person to being a patient. Now, they have the sick role. They have to go for checkups and tests and treatments … I just don’t think we [prevent diabetes] by making every healthy person a patient.” @EricTopol lauded the article, calling prediabetes “mass, dumbed, down medicine and scaremongering one of three (84 million) adults and 1 billion people worldwide, supported by pharma, propelled by guidelines from trusted organizations … with 80 percent of such individuals at no risk.”

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Dear HIMSS Media, I’m confused – is this event in Santa Clara or LA?

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In an attempt to prevent hospital readmissions, researchers at the Rochester Institute of Technology in New York develop a sensor-embedded toilet seat they say can detect deteriorating conditions in congestive heart failure patients.


Sponsor Updates

  • PMC Regional Hospital (IN) completes its Meditech Expand implementation with help from Engage Consulting.
  • EClinicalWorks will exhibit at the AAPM Annual Meeting March 7-9 in Denver.
  • Ellkay will exhibit at the ACMG Annual Clinical Genetics Meeting April 2-6 in Seattle.
  • EPSi will exhibit at the Metro New York HFMA Chapter’s Joseph A. Levi 60th Annual Institute March 7-8 in Uniondale.
  • Healthfinch publishes the third e-book in its refill optimization series, “Achieving Refill Protocol Consensus.”
  • Huntzinger achieves a score of 96.4 in the HIT Advisory Services Category of the “Best in KLAS Software & Services 2019” report.
  • Hyland releases a new enterprise search solution as part of OnBase content management platform.
  • Imprivata will exhibit at SoCal HIMSS March 12 in Duarte.
  • Mobile Heartbeat invites vendors with complementary solutions to integrate with its CURE Connect API Suite via its new CURE Connect Interoperability Program.
  • NPR profiles Kentucky Hospital Association, Kentucky Office of Rural Health, and Collective Medical efforts to develop a statewide care coordination network.
  • Apixio announces that it has grown its customer base to 36 health plans and provider groups, and has analyzed 11 million documents for Medicare Advantage and private plan beneficiaries.
  • Netsmart earns multiple top Black Book awards across behavioral health and post-acute healthcare settings.
  • Sansoro Health makes available a cloud-hosted test environment for digital health companies and health IT developers to test application workflows in a real EHR environment.
  • PatientPing announces that its national network of ACOs generated over $100 million in shared savings for 2017 under the CMMI Next Generation ACO Program.

Blog Posts


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EPtalk by Dr. Jayne 3/7/19

March 7, 2019 Dr. Jayne 2 Comments

My sci-fi nerd flag was flying high when I heard that the Amazon, Berkshire Hathaway, and JPMorgan Chase venture will be called Haven. That was also the name of a planet featured in “Star Trek: The Next Generation” and one where the Enterprise crew was supposed to have some well-earned rest and relaxation. I’ve perused the website and appreciate the way they’ve spelled out their mission clearly and in a way that most people can understand. It looks like most of the open positions are in their Boston and New York offices. It will be interesting to see what kind of people gravitate there.

Researchers are seeking to use artificial intelligence to help design better vaccines against the influenza virus. Flu is a virus that mutates rapidly. Researchers from two pharmaceutical companies are taking biochemical data from samples of exposed patients and running them through an algorithm in an attempt to understand how an effective immune response forms. Other teams are using machine learning to predict the spread of influenza using training data sets from physician offices, hospitals, and social media. The Centers for Disease Control maps flu trends, but being able to truly forecast flu activity would be an asset. I hope they hurry up and get it right. I’ve avoided flu for most of my medical career, but it hit me this week and with a vengeance.

In Mr. H’s annual reader survey, there were some responses that indicated a desire to see more focus on less-traditional areas of healthcare IT, including telehealth. Since I’ve been doing some of my own explorations in the telehealth realm, I’ll share my observations and findings.

One of the first things I’m finding is that it’s important to understand what you mean when you start talking about telehealth. Is this provider-to-provider, institution-to-institution, or direct-to-consumer? The differences involved in the various approaches are vast.

In talking with physicians, there is good acceptance of the provider to provider offerings, which can help serve rural areas or places that don’t have the specialists needed to care for patients with certain conditions. This typically involves a patient coming in to see their provider, then joining with a subspecialist or other clinician via video call. The provider who is actually with the patient can assist with physical exam findings and vital signs. It doesn’t have to be a physician, but can also be a nurse or other trained member of the care team.

This approach can be huge as far as saving time and money for patients to travel to see subspecialists, understanding that some patients just wouldn’t go because of the burden. I’m seeing this more as academic medical centers partner with outlying organizations and it seems to really be taking flight in the pediatric subspecialist world.

There is also good acceptance of institution to institution telehealth, such as remote ICU monitoring or telestroke management services. This can allow specialists to weigh in on the care of patients at institutions that might not have the level of expertise needed to care for certain conditions. It can also just serve as an extra set of eyes for an already-skilled facility, making sure that nothing is missed in the care of critically ill patients. There are typically deep linkages between the organizations from both contractual and philosophical perspectives, so the level of trust is high.

Telehealth services that are delivered directly to the consumer have variable uptake. Some healthcare organizations have already built robust telehealth programs, allowing their providers to work directly with patients who may have challenges traveling to the office. Devices can be used to report patient-generated data in order to provide better care, such as daily weights for heart failure patients or blood glucose readings for diabetic patients.

Other organizations may be using telehealth strictly for acute visits, allowing physicians to extend their hours, access, and productivity without having staff in the office for an extended session. They may be using a telehealth platform within their EHR or licensing with one of the nationally-known telehealth companies to get this done.

Then there are the independent telehealth organizations that may contract with employers or payers, or may market directly to patients as consumers.

I think providers are skeptical of the independent telehealth organizations. There was recently a raging editorial from one of the leaders of the American Academy of Family Physicians on the topic. However, there’s no question that these services are filling a gap in services that aren’t being provided by brick and mortar clinics or traditional primary care practices. Although there are some direct-to-consumer organizations that seem fairly profit motivated, others have significant interest in measuring clinical quality and patient outcomes along with patient satisfaction and efficiency metrics, just like an in-person practice would. These organizations are doing work to explore how they can fill gaps in care while maintaining antibiotic stewardship and clinical quality. They’re also working to ensure that the loop is closed with reports to primary care physicians so that there is continuity of care.

The challenge for these organizations is the lack of data looking at telehealth care of various conditions. There simply isn’t a body of research (yet) that looks at the effectiveness of a telehealth history and examination vs. an in-person examination. We know that physicians have treated certain conditions over the phone for decades, yet there are challenges when it is a brand-new patient-physician relationship rather than an existing one. Smart organizations are gathering data on their outcomes and their approaches and using it to drive future care pathways.

I think we’re going to see a continued boom in telehealth including expansion into the primary care and chronic care space. There will also be plenty of room for specialized telehealth organizations to flourish. Patients are voting with their pocketbooks on convenience and access and I hope traditional organizations are making note.

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The Epic campus has made it into Atlas Obscura,one of my favorite sites for internet time-wasting. I had heard about many of the features, but not the medieval drawbridge, which caught my attention. I’ve never been, but I hear it is something to behold.

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Morning Headlines 3/7/19

March 6, 2019 Headlines No Comments

Health records giant Epic temporarily halts additions to its app store because of privacy concerns

Epic confirms it stopped accepting new apps into its App Orchard last December while it reviewed the security and privacy policies of some third-party developers. We reported and confirmed this with Epic on February 18.

VA to Pilot Health Records System in March 2020

The VA will begin piloting its new Cerner EHR next year at three facilities in the Pacific Northwest.

Amazon-JPMorgan-Berkshire Health-Care Venture to Be Called Haven

Amazon, Berkshire Hathaway, and JPMorgan announce via a new website that their year-old healthcare venture will be called Haven.

Readers Write: HIMSS, Innovation, and the Infomercial

March 6, 2019 Readers Write No Comments

HIMSS, Innovation, and the Infomercial
By David Lareau

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

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Nothing compares to the annual HIMSS conference in terms of providing educational and networking opportunities for health IT professionals. The recent event in Orlando included 300+ educational sessions, dozens of receptions and parties, and multiple days for scheduled and impromptu meet-ups with other attendees.

And then there is the Exhibit Hall. Perhaps I am jaded from my many years in the industry, but I can’t help but feel that the exhibition portion of HIMSS is a bit like a three day-long infomercial, with vendors pitching solutions to problems that many don’t realize they have (the Wearable Towel, anyone?), or for products that sound too good to be true (can you really say goodbye to flab with the ThighMaster?)

Interestingly, many of the “solutions” I saw at HIMSS were designed to fix problems that were created by other “solutions.”

Case in point: EHRs. The inefficiencies and deficiencies of EHRs are well documented. We’ve all seen the surveys about how frustrated doctors are with EHRs, which add to administrative burdens and contribute to physician burnout. Of course, EHRs have long been touted to be time-saving tools that improve patient care and allow physicians to go home earlier. The reality, however, is that few EHR implementations have lived up to all the hype.

But wait, there’s more

Full disclosure: my company was one of the 1,300 exhibitors at HIMSS this year serving up our own brand of infomercial, though I’d like to think we fall more in the Roomba category (innovative and useful) than Chia Pet (just why, people?)

We conducted a non-scientific survey in our booth to better understand providers’ biggest EHR challenges. When asked “Which health IT challenge are you most surprised is still an issue for the industry?” our 361 participants (all of whom were given a chance to win a prize) indicated the following:

  • Lack of interoperability between EHRs and between providers: 36.1 percent
  • Clinician dissatisfaction with EHRs: 27.7 percent
  • Difficulties using data to improve clinical and financial outcomes: 22.6 percent
  • Lack of innovation compared to other industry sectors: 13.5 percent

What these results tell me is that despite years of hype, EHRs still need fixing on multiple fronts in order to meet the needs of users and advance clinical and financial incomes.

Money-back guarantee

Providers have spent billions over the last couple of decades implementing EHRs that have failed to adequately deliver the efficiencies that clinicians require. Even if health systems and physicians could take advantage of money-back guarantees, few could afford the time, disruption, and additional investment required to rip out legacy systems and implement new solutions.

What are frustrated providers to do?

Not available in stores (but perhaps as seen on the HIMSS exhibit floor)

Despite the industry’s failure to realize the promise of EHRs, at HIMSS this year I saw increased interest from providers looking to improve the usability of their existing EHRs. More vendors are offering app-based solutions that extend the value of EHRs without the disruption of implementing a brand, new platform.

Some of these technologies are designed to fix inefficient workflows that diminish physician productivity. Others focus on organizing existing data so that clinicians can easily access the right data at the right time for the right patient – even if that data is coming from an outside system. Additional offerings enable more complete and accurate documentation to facilitate quality care, correct reporting, and better clinical and financial outcomes.

You can do it

I am encouraged that despite the plethora of pitchmen hawking products almost as seemingly frivolous as the Snuggie, I saw more signs of innovation at HIMSS19, especially for solutions that consider the needs and desires of clinicians and support better outcomes for patients.

The HIMSS Exhibit Hall may indeed be reminiscent of a marathon infomercial, but consider this: without infomercials, millions might never have enriched their lives with George Foreman Grills, P90X workouts, or the ShamWow.

HIStalk Interviews Randall, An Anonymous Health System CIO

March 6, 2019 Interviews 4 Comments

I invited health system CIOs to interview with me anonymously, knowing from unfortunate personal experience that health systems don’t like their executives going off script to a national audience. Randall (not the interviewee’s real name) offered to spend 20 minutes on the phone with me to talk about what it’s like on the front lines. CIOs willing to do the same can contact me to arrange a fun conversation.

What are the hardest parts of being a health system CIO?

You serve many masters. The administrative area — the CEO, CFO, CMO — each have different objectives, goals, areas of influence, and levels of influence. Then you have your physician population, both from the acute care setting and employed physicians in the clinics. You have the masters of the regulators and dealing with the Promoting Interoperability Program at both the federal and the state level. You have operations, the directors and managers who are dealing with patient care or the revenue cycle or finances for the hospital. You also have another group to deal with in vendors and contractors.

At the end of that, you have your staff. You have a workforce that’s dealing with the same types of pressures you are at the CIO level, but they get it day-to-day in the field. You have to encourage them, empower them, and coach them to deal with that environment. That takes a very special set of people with their goals and their work ethic aligned with the organization to keep them going. Otherwise, they’re looking at it as just an IT job. They probably won’t survive in the healthcare space very long.

It’s a challenge and it’s a lot of juggling, but I chose this industry because it is challenging. It changes and requires you to think on your feet, to plan, and be strategic. It is not a boring job, that’s for sure. It can be frustrating at times, but it can also be very rewarding. You go through these challenges with people who you spend quite a few hours with, do a lifetime of work with, and you can identify with each other on each other’s challenges. You build some pretty strong relationships.

At the executive table, how do you reconcile what everybody wants in making sure that IT’s contribution fits into the overall health system strategy?

That’s the unique position that we are in as IT. We are exposed to all the workflows, especially on the applications side. We know the upstream and downstream effects that changes have. We know the benefits of using a technology, but we also know the downfalls of not planning it out well.

Those around the leadership table have a difficult time. They have to consider the mission and strategic plan while compromising around a single goal of achieving that strategy, but they have their own needs in their departments or with a particular physician.

We talk about flexibility all the time. But we have to set a course and not just stay the course. We have to support each other through those difficult decisions, what might be great things to do that would detract from what we already agreed are our priorities.

In each senior leadership team meeting, I say, here are all the things we’ve committed to. Here are the estimated hours the IT team alone needs. But we’ve already committed more hours than are available over the next six months. Then the CEO starts to look down the list of projects to ask for each one, why are we doing this?

When they start to dig into the projects, they circumvent the original decisions that were made by the VPs to execute on those projects. They are looking to the CIO to say what the priority should be. The other side of that sword is that two years ago, there wasn’t much governance going on in this organization. Senior leadership and directors were complaining, “IT is telling us what to do.”

OK, which is it? Do you want us to provide the guidance or do you want us to just facilitate it? That’s a challenge. There’s a balance there. This particular organization is having a lot of struggles getting into a more formalized initiative and governance process around their projects — not just in IT — and understanding what resources are involved with those. When they make changes, what impact does that have on projects that have already started?

Are executives worried about high software maintenance costs?

I don’t necessarily see that as an issue here. We cover that pretty well during the budgeting process for capital stuff. Maintenance is budgeted. It is a big nut, a large number. The board sees the percentage of operating expense coming from the IT area on things like maintenance continuing to climb, so they are aware of it.

The bigger challenge for this organization on its maturity curve is that when they look at a solution and they’re working with a vendor, it tends to be siloed around just the solution. What about the upstream effects or needs for your system and the downstream effects?

I’ll give you an example. We have a rather old cardiology rehab system that is documenting patient care. It needs to be replaced because it is no longer supported, but they want to interface that information into the main hospital system. But what they submitted for consideration was just the software and the maintenance for just that piece of software. Nothing about the IT hours needed for integration and the cost for the other system to do the integration.

IT ends up becoming the bearer of bad news on every single project for unplanned cost. It’s not just maintenance, but presenting the entire package of everything that’s involved with a particular initiative so that we don’t have any surprises.

Unfortunately, we’re still having surprises. Vendors don’t want to share that information. The sales folks want to close that deal as quick as they can, The standard feedback from them is, “You won’t need any IT support.”

What is good and the bad about having a few limelight-seeking CIOs representing those who just stay home and get their employer’s work done?

The good is that they sometimes expose you to other things that are available. The bad is that they represent themselves as the experts based on experience and most of them don’t have the experience. They are out there interacting with vendors and other industry people who have a particular agenda to address. Rarely have those who are popping up all the time been involved in implementations and dealing with the interactions with the physicians and the staff, both their own staff and the staff in the hospital. They are ego stroking. Hey, look what I know.

For me, it doesn’t necessarily translate into experience, lessons learned, and how I might be able to do that in my particular environment at a community hospital or a large health system. Other CIOs have actually been in the field, but they are few and far between and also in high demand.

I liken them to the chief medical officers that have grown up through an organization. They have a difficult time balancing the days that they’re in the clinic and treating patients with all their administrative responsibilities of the medical staff and administration. It’s a tough job. I always appreciate when those kinds of individuals who have real-world experience are willing to share that information.

The guys that are out there on LinkedIn and all the publications out there, telling you that “this is what you should be doing,” I have to take that with a grain of salt. It’s great to hear about what things are available out there, but sometimes they have to bring it back to bit of reality and what hospitals can actually do.

What kind of information sharing is most effective for a CIO who has to work for a living and who doesn’t have unlimited budget or time to self-promote?

CHIME has been a pretty good forum for CIOs to share information, although I’m starting so see it morph a little bit towards what HIMSS has become. I’m hoping they hold the line and don’t go that far. Those interactions between CIOs, one on one and sometimes in smaller groups, tend to be most valuable to me.

Every once in a while, I will reach out on the MyCHIME bulletin board to explain something I’m trying to solve and ask, has anybody gone through this? Some people like to share what they have done and what they have been challenged with, but not in an open and public environment out there like a magazine or something like that.

Is it too late for HIMSS to reel in vendors and is CHIME is too far along the path to do the same? Or is there no inherent conflict between what vendors want and what provider members want?

That’s the hard part. I don’t know that I have a solution for that. Vendor involvement is somewhat of a necessarily evil. Their motivation, no matter what they say, is that they have a business to run. They have to grow. They have to generate sales. They may have a great product, their company may have started off with a great idea and just grew from there, but in the end, they have to generate more leads. That’s the nature of our economic engine.

I find it a really difficult job for HIMSS to do. But at this year’s HIMSS, I was actually a little bit pleasantly surprised by the education sessions that I went to. Vendors weren’t running those presentations like they did in the previous couple of years. It was a little bit more low key with the vendors this year.

CHIME does a pretty good job of asking vendors to establish relationships with CIOs rather than coming in and doing hard sales. They do that through their focus groups, which is a pretty good idea, having five or 10 CIOs or senior IT leaders talking with a vendor about what their future plans are and what problem they are trying to solve.

I’ve been to a few focus groups that involved a solution looking for a problem. But in those focus groups, the CIOs are emboldened by each other being in that room and helping each other out. They give the vendor feedback and sometimes tell them straight up, this isn’t a problem we’re trying to solve. Or they’ll tell them, this is a great idea, but have you thought about it in this area? Trying to tweak or mold their solutions to that particular problem.

A good example from CHIME is that a year or two ago, I was on a focus group with the IBM Watson people. The entire room kept saying, what are you really delivering here? IBM Watson basically ignored all the feedback, at least based on the public perception that’s out there now. They still haven’t delivered. It’s a great idea in terms of what it might hold in the future, but overhyping on the front end doesn’t really help them. It destroys your reputation when you can’t deliver.

Health systems claim to embrace innovation, consumerism, and value-based care, but they still use fax machines, offer a poor visitor experience, and make a fortune by cranking out fee-for-service work. Is there a difference in what hospitals say versus what they are motivated to do?

Value-based care is BS. You are talking about trying to get to a subscription model with a patient. If your clients, your patients don’t want that and don’t feel a need to do it, then you are forcing a business model on them that won’t work. They don’t want it. They don’t feel the need for it. They just expect delivery of high-quality care episodically when they are ready and they need it. I don’t know that a hospital can solve that problem.

Hospitals and clinics can become more consumer-centric. As an administrator or an IT person, when you go to a clinic or hospital, what do you expect as a patient to be delivered that you might get from other types of industries? You would like to be able to do things on your smartphone. You’d like to be able to schedule appointments online. You’d like to be able to get your medical records freely and easily.

We have to back away from the regulatory demands and the billing demands and get on the front end of the consumer. Because in our environment, in our US of A, everything is based on capitalism, and he who builds the better mouse trap is going to draw more customers.

I don’t know how we will ever make that transition to value-based care unless you have a single-payer system, which I’m not an advocate of. But I don’t know how else you can do that. You are forcing patients into having to become subscribers to a healthcare service rather than episodic paying for what I need, when I need it. That’s my opinion, but the current environment pays my paycheck and I have to operate within it.

Morning Headlines 3/6/19

March 5, 2019 Headlines No Comments

FDA chief Scott Gottlieb resigns

FDA Commissioner Scott Gottlieb, MD resigns, effective next month.

ZOLL Acquires Golden Hour Data Systems

Medical device maker Zoll Medical acquires Golden Hour Data Systems, which offers charting, RCM, and hospital integration software for EMS companies.

TRHC Announces Acquisition of PrescribeWellness Expanding its Medication Risk Mitigation Offering

Medication safety software vendor Tabula Rasa HealthCare acquires pharmacy-focused patient relationship management technology business PrescribeWellness for an undisclosed sum.

News 3/6/19

March 5, 2019 News 4 Comments

Top News

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FDA Commissioner Scott Gottlieb, MD resigns, effective next month. He resignation letter did not indicate the reason for his departure from the job he has held since May 2017.

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Gottlieb was a supporter of digital health technologies and modernization of FDA’s approach to regulating them. That included development of FDA’s Digital Health Software Precertification Program that allowed certified software vendors to fast-track their products to market. He also advocated using EHR data for post-market electronic safety surveillance of drugs and medical devices.

The 46-year-old Gottlieb previously worked for FDA in 2002-2003 and 2005-2007 and was a venture partner specializing in healthcare from 2007 until he was appointed FDA commissioner.

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Gottlieb tweeted on January 3 that he was not leaving FDA, a denial that was apparently greatly exaggerated.


Reader Comments

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From Minor Trauma: “Re: HIMSS Analytics. Now that it’s owned by Definitive Healthcare, should they still be using the HIMSS ‘not-for-profit’ position in soliciting survey responses, especially when working with PwC, another commercial org?” Definitive Healthcare didn’t buy HIMSS Analytics – they bought the HIMSS Analytics provider data business. HIMSS kept the consulting business, mostly involving its various Adoption Models, and that work (including this survey) will continue under the HIMSS Analytics name. Definitive CEO Jason Krantz responded to my inquiry on your behalf as follows:

Definitive Healthcare bought the data services part of HIMSS Analytics, which collects and provides data and analytics on the healthcare provider community. The data assets and clients of this part of the business will be entirely integrated into the Definitive ecosystem, which should be massively beneficial to those clients as we combine the best of both products. HIMSS Analytics will, however, remain an ongoing concern with a renewed focus on their mission of helping healthcare providers utilize technology more effectively to drive improved patient outcomes. In essence they are providing consulting services to providers with a focus on goals that are consistent with their non-profit objectives.  

From Digital Native Uprising: “Re: HIMSS. How much did it receive for its sale of the data business of HIMSS Analytics?” The number wasn’t announced and Jason Krantz from Definitive Healthcare (as I asked him the question above) was obviously not willing to provide details. Long-timers will remember that HIMSS originally bought that business from someone else whose name I’ve forgotten in 2003 and renamed it the HIMSS Solutions Toolkit. I always wonder how much HIMSS paid for acquisitions such as Healthbox and Health 2.0’s conferences, not to mention the mostly forgotten acquisitions of the rights to Disruptive Women in Healthcare, the MHealth Summit conference, the Medical Banking Project (apparently still around with HIMSS under John Casillas), Health Story Project, Microsoft Healthcare Users Group, and several other organizations that were rolled up into something bigger that no longer use their original names.

From Bohn E. Maroney: “Re: Orlando Health’s venture capital arm. Is it ethical for health systems to create or invest in for-profit businesses?” I admit that it makes me nervous when someone who is making healthcare decisions on behalf of a patient – whether it’s a hospital with private company investments, a doctor earning royalties, or the average for-profit medical practice — stands to benefit financially from ordering a particular course of therapy. I don’t think financial influence would encourage them to knowingly harm a patient, but it might sway them toward overuse, especially if the patient risk is low and their insurance company is footing the bill. That’s why we have a zillion times more diagnostic imaging machines than pure science says we need and armies of drug company reps living in mansions. We set ourselves up for disappointment in hoping that doctors and hospitals will act more nobly than the rest of society in declining to take the perfectly legal action that benefits them most. In all aspects, conscience has proven to be an ineffective deterrent to questionably ethical behavior.


HIStalk Announcements and Requests

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I just read this book that Datica was offering at HIMSS19 and found it to be very good, especially given my modest knowledge of the technical underpinnings, business imperatives, and legal considerations of cloud computing. The authors are Datica CEO/Chief Privacy Officer Travis Good, MD and Chief Marketing Officer Kris Gösser. It finally convinced me that cloud isn’t “someone else’s hard drive.” Coincidentally, I just read that Lyft’s IPO documents reveal that it pays $100 million per year to Amazon Web Services for cloud computing services. 


Webinars

March 6 (Wednesday) 1:00 ET. “Pairing a High-Tech Clinical Logistics Center with a Communication Platform for Quick Patient Response.” Sponsored by Voalte. Presenters: James Schnatterer, MBA, clinical applications manager, Nemours Children’s Health; Mark Chamberlain, clinical applications analyst, Nemours Children’s Health. Medics at Nemours Children’s Health track vital signs of patients in Florida and Delaware from one central hub, acting as eyes and ears when a nurse is away from the bedside. Close monitoring 24 hours a day integrates data from the electronic health record, such as critical lab results, and routes physiological monitor and nurse call alerts directly to the appropriate caregiver’s smartphone. This session explores how the Clinical Logistics Center and more than 1,600 Zebra TC51-HC Touch Computers running Voalte Platform connect care teams at two geographically dispersed sites for better patient safety and the best possible outcomes.

March 27 (Wednesday) 2:00 ET. “Waiting on interoperability: What can payers and providers do to collaborate?” Sponsored by Casenet. Presenter: Amy Simpson, RN, director of clinical solutions, Casenet. A wealth of data exists to identify at-risk patients and to analyze populations, allowing every payer and provider to operate readmissions intervention and care management programs. Still, payer and provider care managers are challenged to coordinate and collaborate to improve outcomes because of the long road ahead to interoperability. Attend this webinar to learn what payers and providers can do now to share information and to coordinate their efforts to create the best healthcare journey for members and patients.

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


Acquisitions, Funding, Business, and Stock

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Medical device maker Zoll Medical acquires Golden Hour Data Systems, which offers charting, revenue cycle management, and hospital integration software for emergency medical service companies.


People

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ROI Healthcare Solutions hires Jeff Tennant (Leidos) as executive director of revenue cycle IT services.

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Practice Velocity hires Deven Shah (FTD) as VP of software development.


Announcements and Implementations

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AHIMA and Artifact Health will offer templates and a mobile app for delivering compliant physician query templates, which means coders asking doctors to clarify their documentation for accuracy and maximum payment.

The Sequoia Project will hold a public forum webinar on the federal government’s proposed information blocking policies on March 19 as part of its Interoperability Matters initiative.

A smallish survey of senior healthcare leaders finds that two-third of health systems have rolled out executive dashboards to aid in decision-making, but rarely use them daily. The survey also found that healthcare systems use an average of four analytics tools, while one in six of them use 10 or more.


Privacy and Security

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This is true of healthcare, too, where collecting and selling patient data is everywhere. In related news, Facebook gets caught for its practice of harassing users to provide their telephone number to support two-factor authentication, then immediately using that number to target ads, with the newfound twist being that Facebook allows looking up users by their telephone number with no opt-out provision. Also like healthcare, Facebook does little to correct wrongdoing until it makes headlines.


Other

A Health Affairs article warns that “consumer-driven healthcare” is an appealing-sounding but potentially harmful health reform concept because healthcare isn’t a classic market that can be shaped by consumer actions. Patients don’t understand healthcare, they don’t choose providers based on quality and price, and their insurers don’t have enough bargaining power to drive down prices, so health reform that is based on consumerism is likely to fail. It also notes that, unlike in other markets, giving patients what they want in a “customer is always right” model can compromise provider integrity and result in patient harm.

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A startup in Japan develops AI-powered software for existing closed-circuit security cameras that can detect shoplifters by their suspicious body language such as fidgeting, potentially allowing employees to deter their crime by asking them if they need help. The company’s website lists possible healthcare uses, such as detecting poor physical condition, and I can see hospitals using it to identify hospital visitors who are struggling to navigate the usual consumer-unfriendly hallways, although if hospitals cared that much, they would probably address the problem rather than the symptom.

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Another interesting Health Affairs article looks at how patient portals have been integrated into the care processes of four health systems:

  • Ochsner Health System has created a hypertension program in which patients complete surveys about their diet, exercise, medications, and social determinants of health via Epic’s MyChart; are issued a blood pressure device that sends their readings directly to MyChart; are offered help with using digital tools via a Genius Bar-type desk; and are monitored by a care team that includes pharmacists and health coaches. Blood pressure control and patient satisfaction have improved and PCP visits have been reduced by 29 percent.
  • Sutter Health has convinced 79 percent of ambulatory care patients to use its Epic patient portal and has motivated clinicians to respond to patient  messages by using a triaging system and offering them incentives for answering messages within one business day. Patients are also using the portal for online scheduling, appointment wait-listing, and booking video visits.
  • Stanford Health Care invites patients to sign up for MyChart via a text message and automatically verifies their sign-up identity by asking questions about publicly available data, which has increased primary care patient enrollment to 87 percent. The portal also allows patient check-in, facility way-finding, and Open Notes chart information access. It is also being used to survey patients about unaddressed symptoms and needs. Stanford also shares all physician notes, other than those related to mental health, across all disciplines.
  • UC San Diego Health offers inpatients the use of tablets from which they can manage room settings (lights, shades, thermostats) and access Epic’s MyChart Bedside inpatient portal to review meds, procedures, test results, care team members, and educational materials.

Sponsor Updates

  • Cantata Health’s NetSolutions and Optimum platforms win Black Book’s highest satisfaction awards for ERP, long-term care, and hospital revenue cycle management.
  • OptimizeRx will present at the annual Roth Conference March 17-19 in Orange County, CA.
  • Healthcare Growth Partners posts its February health IT insights.
  • Bernoulli Health receives ISO 13485:2016 and Medical Device Single Audit Program certifications from Intertek.
  • Nancy Landman (IBM) joins The Chartis Group’s Information & Technology Practice leadership team.
  • DrChrono expands its partnership with CoverMyMeds, offering end users electronic prior authorization and support services, and prescription pricing transparency.
  • STAT profiles Nuance’s new ambient listening system for patient encounters.
  • Aprima will exhibit at the LHC Group Revenue Cycle Leadership Conference March 11-12 in New Orleans.
  • Atlantic.Net CEO Marty Puranik weighs in on a Facebook feature that lets people look up users by their phone number or email address.
  • Bluetree donates 624 trees to the National Forest Foundation at HIMSS19.
  • Healthfinch publishes an ebook titled “Achieving Refill Protocol Consensus – Best Practices for Creating and Maintaining Protocol Content.”
  • DrFirst’s RCopia is certified as compliant with the NCPDP Script 2017 e-prescribing standard.
  • NJ Biz profiles CarePort Health.
  • CareVive names Ethan Basch, MD (UNC School of Medicine) director of its Scientific Advisory Board.
  • ChartLogic will exhibit at the AAOS annual meeting March 12-16 in Las Vegas.
  • The Silicon Slopes podcast features Collective Medical CEO Chris Klomp.
  • CoverMyMeds will exhibit at the MHA Business Summit March 6-8 in Las Vegas.

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Morning Headlines 3/5/19

March 4, 2019 Headlines No Comments

Red flags for Nova Scotia’s electronic health records mega-deal

Critics of Nova Scotia’s One Person One Record project, for which Allscripts and Cerner are the vendors being considered, note Cerner rollout problems in Australia’s Queensland Health, South Australia’s planned overhaul of its Allscripts-powered EPAS project, and a poorly run Cerner implementation at British Columbia’s Nanaimo Regional General Hospital. 

This hospital modeled itself after the Apple Store, and lets pregnant mothers use gadgets to monitor their health at home

Ochsner Health System (LA) develops Connected MOM, a free remote patient monitoring program for expectant mothers that incorporates digital health tools accessible at a Genius Bar-styled area of the hospital.

Amazon Gives AI to Harvard Hospital in Tech’s Latest Health Push

A $2 million grant from Amazon enables AWS and Best Israel Deaconess Medical Center (MA) to determine how machine learning and AI can help improve workflows, diagnoses, and treatments.

Curbside Consult with Dr. Jayne 3/4/19

March 4, 2019 Dr. Jayne 1 Comment

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Due to bad weather, I was gifted a fairly quiet and unremarkable urgent care shift today. I definitely appreciated the time to allow my brain to play catch-up. Word of advice: if you get blackout drunk at a Mardi Gras party and wind up with a visibly deformed leg, I hope you have sober friends who can take you to the emergency department immediately. Waiting until the next day and then going to urgent care for your nine-way fracture isn’t going to be as helpful.

I’m working on a couple of projects, one involving creation of some new educational resources for an organization that is pursuing EHR optimization. It’s often difficult to figure out the best way to train people, and successful organizations will use multiple methods to ensure that everyone is receiving information in the way that best suits them. Those organizations also use frequent retraining to ensure the information is retained.

Out of all the organizations I’ve worked with over the years, only two had individuals with advanced training in adult education involved in the creation and upkeep of the training process. Too often, training is done “like we did it last time” and doesn’t take advantage of different types of media and experiences.

Some people are visual learners who are going to respond best to well-delivered presentations and written materials, often taking notes on the content. These folks may do well with classroom presentations as long as they’re organized and concise and have dynamic presenters that don’t bore the audience to death. Others are auditory learners who may also do well with a classroom format. Still others are kinesthetic learners – they need to touch, feel, and do to absorb workflows they are trying to learn. They do best in a lab setting. There are also variations on the various learning styles, including whether people learn better individually or in a group setting.

Too often leaders make assumptions about how their people should learn,  limiting the options that are offered and potentially to negatively impacting a subset of their users. Savvy organizations poll their users and see what kinds of training materials they would like to have.

LOINC recently surveyed their core users and the breakdown was interesting. Of nearly 500 users:

  • 48 percent preferred a published guide available as a PDF
  • 25 percent wanted written documentation as a web page
  • 6 percent preferred slide presentations
  • 17 percent wanted video presentations with audio
  • 3 percent wanted in-person training

It would be useful for leaders to survey their users to see what kind of training is preferred.

Leadership should also be aware of the corporate culture and how different types of training will be received in the field. For example, one large health system I worked for decided that they didn’t want to expend the resources to bring everyone together for training. They decided to train via web meeting with people at their desks. Participants were not aware that the training team had attentiveness tools, including being able to see whether the window in which the presentation was occurring was the primary focus on the desktop.

Within 15 minutes of the start of the webinar, hardly anyone still had the session in primary focus, and of those who did, they were most likely multi-tasking based on the lag in their responses to interactive polling questions. Others never even signed in to the webinar because they were sidetracked in the office with the urgent issues that occur on a minute-by-minute basis. Had they been allowed to leave the office and attend classroom training, those interruptions and distractions would have been minimized. Needless to say, the training was a flop, and for our next upgrade, we returned to classroom-based training.

One of the things that bugs me the most is training sessions that lack of materials for the participants. Back in the days after the demise of the Kodak slide carousel and following the rise of PowerPoint, lecturers often handed out copies of their slides for attendees to take notes on. As we became more environmentally conscious, people stopped handing out copies, but this left students frantically scribbling and trying to capture concepts and ideas. Some presenters balk at handing out the slides before a lecture for fear that it will make the audience inattentive. This completely ignores the subset of learners that benefit from seeing an overview of material before they’re confronted with a deep dive.

For this new project, I’m working on the scripting that will be used to retrain physicians, including a compilation of the clinical scenarios that are the most relevant to each physician who will attend an in-person session. They will be experiencing a classroom portion followed by a lab, followed by time for individual questions and interaction with the trainers. All of the sessions will be recorded and we’re distributing the materials, both before the class and after. The slides that are sent before the class will allow people to bring a printed copy if they want to, and those distributed after the class will contain notes and annotations from questions and discussion held during the session. Not everyone wants a big shelf full of binders and manuals, but the reality is that some people still like hard copies.

The other project I’m working on is more creative in nature, a communication and marketing plan for a practice that is planning to launch virtual visits. They have decided to try to do them in-house using their EHR, which doesn’t have great telehealth functionality, but at least they’re willing to dip their toes in the water to see whether patients are interested in it. We’re putting together communications to make sure everyone in the office is aware of the project and the plan to launch it as well as the questions they will need to be able to answer when patients ask.

Figuring out the best way to market it to the patient population is also a challenge. The majority of them are tech-savvy, but will need some education on why they will be billed for a virtual visit that in the past would have been handled as an unreimbursed phone call. It’s been fun to come up with the flyers illustrating the difference as well as doing some role-play with the leadership to make sure they can articulate all the goals and objectives before we roll the materials out to the front-line staff. I’m enjoying working with people who are willing to lead by example and to roll up their sleeves instead of just delegating something this major to someone down the line.

A nice creative project helps get my brain working again after this long awful winter. Even though snow is still on the ground, I’m starting to feel like spring might finally be around the corner.

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