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Curbside Consult with Dr. Jayne 4/29/19

April 29, 2019 Dr. Jayne 2 Comments

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As much as we complain about our technology, there are days when I’m glad to have it. This week was one of those, when I was confronted with multiple patients who had been exposed to wild animals and I had to quickly determine whether rabies exposure was a risk in our area.

Barely a decade ago, this question would have required a fair bit of research and possibly a phone call to the county health department. Although we determined that being scratched by a squirrel wasn’t considered a risk factor because the incidence of rabies in the squirrel population in our area is relatively low, apparently the largest reservoir in our area is the woodchuck. I always thought they were a slow animal that doesn’t do much, but apparently when they are rabid, they will chase people. I’ll be on the lookout for any deranged woodchucks on my upcoming outdoor adventures.

It’s also fantastic to have data from the Centers for Disease Control at our fingertips – where we are in the current influenza season (almost done!), how many people have died this year (fewer than 55,000 compared to last year’s 80,000), and what the current recommendations are for our patients who are traveling to various parts of the world.

When I work with physicians who complain about having to use computers in the exam room, I challenge them to think of ways that computers are beneficial and how they might learn to better use the computer as part of the patient visit rather than fight it. Even the most reluctant physician can usually think of a handful of positives.

Some of the concerns I hear from physicians are part of a larger issue with organizational dynamics. I was pleased to see a recent editorial in the Journal of the American Medical Association addressing the need to build trust as part of relationships between clinicians and healthcare organizations. The authors note that although many books cover this in the business world, there is little addressing how it impacts clinician relationships with their employers or sponsoring organizations. They note that we have likely arrived at this place of mutual distrust due to the size of many healthcare organizations and the insertion of management layers between frontline clinicians and senior leadership.

Often changes that are being driven by payers or the market result in hostility towards organizational leaders. I see this often in the EHR trenches, as providers fail to fully understand the role of government mandates and payment incentives / penalties in driving EHR use.

The authors also cite poor communication as a key reason for lack of trust. I agree wholeheartedly with that assertion. I still see organizations that have fractured communication pathways. This may result in chain-of-command communications that reach clinicians at different speeds and sometimes not at all, or inconsistency in the messaging.

During some of my interim CMIO engagements, I’ve seen meetings canceled with no explanation, which leads to feelings of uncertainty and a lot of time spent by invitees in trying to figure out why it was canceled or whether policy has changed. It’s unfortunate because a simple explanation with the meeting cancellation would have created a lot of goodwill – “canceled due to schedule conflict, will be rescheduled” would go a long way to silence what I’ve seen turn into full-blown organizational conspiracy theories.

They note other drivers of distrust, such as “poorly conceived or implemented electronic health records, competing interests, and misaligned incentives” that add to the confusion. Other factors include a perceived lack of clinician input, overly rapid changes to processes or metrics, administrative burden, and inadequate support staff. They also note that clinicians struggle to buy in when standardized care processes are discussed along with other changes that might negatively impact clinician autonomy.

I agree with the authors that it is easy to violate trust and extremely challenging to rebuild it. They call on organizations to engage “leaders who are visible, available, and responsive and who know how to develop and foster positive relationships.” Having worked with several boorish leaders over the last several years, I’d also suggest that leaders be educated on their constituents and how they will perceive anecdotal stories that the leaders might throw out.

I worked with one CEO who constantly talked about his ski trips, his sailboat, and his house in Jackson Hole. Let’s just say that didn’t resonate with primary care physicians who were driving 10-year old Hondas. Nor did the story about the year he took off work to coach his son’s baseball team. Some background research on what made that particular group of physicians tick or what their economic status was might have been helpful and would have saved everyone a bit of angst.

I enjoyed the section that mentioned that “marketing slogans are no substitute for a clearly articulated purpose that is consistently and continually reinforced through action and policy.” One well-known health system had a campaign around “world’s best medicine made better.” What does that mean, exactly? What is the goal? How do frontline physicians play a role?

The authors note that although trust is a two-way street, “organizational leaders are best positioned to take the first step in establishing trust. Clinicians are unlikely to shift from suspicion and disengagement to being fully trusting unless they experience leaders who are trustworthy, but also must act in ways that engender trust.”

I was surprised that there weren’t more comments on the article, only one that identified lack of departmental meetings as a driver of distrust since face-to-face interactions were reduced. We used to have quarterly medical staff meetings at our hospital that were a big deal, with a catered sit-down dinner. Big issues were discussed and the majority of the medical staff made a point to be there. However, as costs were cut, those dinner meetings gave way to lunch meetings, which disenfranchised those of us who didn’t practice on the hospital campus. Those were in turn canceled due to “poor participation” and what used to be a vibrant discussion was reduced to the occasional email blast telling us about the hospital’s priorities.

I’m interested to hear what readers think about the state of trust in healthcare organizations. What is your organization doing well? What could use improvement? Leave a comment or email me. And watch out for rabid woodchucks.

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HIStalk Interviews Dan Dodson, President, Fortified Health Security

April 29, 2019 Interviews No Comments

Dan Dodson is president of Fortified Health Security of Franklin, TN.

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Tell me about yourself and the company.

I’ve been in healthcare for most of my career. I have always been inspired to give back to healthcare and patients. I have an MBA in health organization management and have always been intrigued at the concept of using my business degree to help provide better patient experiences. I’m blessed to do that at Fortified Health Security.

We are a cybersecurity company, a managed security service provider. We provide a wide range of managed services to healthcare organizations to help them combat threats and comply with regulatory requirements.

How does a health system decide where to focus their cybersecurity efforts and funding?

I have that conversation with organizations every day. The majority of healthcare organizations understand that it starts with a risk assessment. Pick a framework and do an assessment. From there, figure out where you have deficiencies or opportunities for enhancements. Every health system is different on what their next step will be, but the core of every good cybersecurity program requires performing an assessment of where you are, then driving your strategy from that.

Then, think about the perceived value of your cybersecurity spending and the actual value that you are receiving. A lot of organizations look to buy the next shiny security tool. The board and C-suite perceive that the purchase of that technology will better protect them from adversaries and from hackers. That is true to some degree, but when we implement those technologies within a healthcare environment and its many nuances, we lose sight of what we actually need to do to operationalize that technology.

I encourage organizations to think about not only how they are deploying capital for buying new technologies or implementing new services, but how they are making sure that they are working in concert with prior investments whether they are supporting them operationally to extract the value that they perceive those tools provide. Tools can be quite sophisticated, but they require people and process to extract their full value. We see a lot of under-implemented, underutilized technology in healthcare organizations that we work with.

Sensationalistic headlines talk about theoretical risks that have never actually happened in the real world, such as medical device hacking and inserting malware in medical images, which doesn’t seem to offer much incentive for a hacker. Are hospitals chasing those hypothetical problems instead of the duller but more dangerous ones that don’t make headlines, such as the usual email-launched attacks?

Certainly some companies and folks are chasing those headlines with their solutions. No single bullet will protect you and secure you 100%. You have to take a layered approach that is appropriate for your organization.

We do a lot around medical device security. The threat to medical devices is real, but we are seeing it manifested by adversaries and hackers using them as a jumping-off point to get to the valuable data, not necessarily to disrupt the clinical performance of that device. They use the medical device to get to EPHI.

What new cybersecurity threats have you seen recently that are most worrisome?

We are seeing a lot of just the fundamental attacks, such as insiders and users and clicking on bad links in email. Those are still some of the highest threats that face organizations. Attacks such as phishing and vishing are increasing and becoming more sophisticated.

We encourage people to think about the fundamentals of a security program. The unsexy things — patching, making sure that they are doing vulnerability scanning, making sure that they are identifying where they have EPHI, monitoring the networks, and looking at logs. The traditional core fundamentals. Often when we peel back the layers of what happened in a big breach, a user inadvertently or purposefully did something, or there was a lack of internal blocking and tackling for security. We encourage folks to think about whether they are executing a good, solid fundamental program before investing in the latest and greatest gear and tech.

Organizations that are forced to admit that they have been breached always claim it was a sophisticated attack and sometimes imply that a state-sponsored hacker was involved, perhaps to make themselves seem to the public to have been more security-aware than they really were. That can lead the organization’s cybersecurity insurers to refuse to pay their claims because they can say that implicating state hackers suggests an act of war that their policy doesn’t cover. What is the level of threat from state-sponsored hackers in healthcare?

Healthcare is vulnerable. ARRA and HITECH spurred rapid digitization that wasn’t always implemented on modern, secure networks and infrastructure. The increased amount of valuable electronic health information is stored on the path of least resistance. State-sponsored attacks and hackers look for the path of least resistance, so we are vulnerable at the onset.

You brought up cyberinsurance, which is important to understand. Procurement of cyberinsurance in a healthcare organization may or may not involve IT or security. It might be procured by the legal or compliance department. A cyberinsurance policy’s actual insurance binder contains the requirements for that policy to be in force. It is important that organizations know what’s in that binder so if they have an incident, they actually get paid.

We are seeing that during the claim review process, cyberinsurers are doing claw backs or denying claims because the organization wasn’t meeting the requirements contained in the insurance binder. That’s a critical area of focus. Don’t get a false sense of security just from having cyberinsurance. You have to make sure you are doing whatever the binder requires. It has gone unfavorably for healthcare organizations that failed to do that.

Why do we keep seeing major information exposure from unsecured servers that are open to the Internet?

Networks have sprawled over time with health system acquisitions and consolidation. We see that every day. This cobbled-together infrastructure and process allows it to happen. We are all shocked when it happens and of course we want to avoid it.

It goes back to the fundamentals and looking at root cause. We need to have asset inventories, know where our EPHI is stored, and understand how it is performing on our network and within our environment. Spending time on the blocking and tackling fundamentals reduces the chance of finding yourself in that situation.

Quite a few breaches were caused by a health system’s third-party vendor. Has anything changed with regard to the role of business associate agreements in a security plan?

It is important to understand third-party risk, the types of data you are sharing, and how you are sharing it. The lines of responsibility have become blurred within the context of those types of relationships.

It’s important to have business associate agreements in place. I always chuckle when I say that because we still find people not doing that. Then it’s important to have risk stratification of those third-party partners to make sure that you understand what they’re doing from a security perspective to better isolate the data that we create and that we’re responsible for safeguarding.

How common is it for a health system to have a chief information security officer position that is staffed by someone whose credentials would qualify them to work outside of healthcare?

There’s a human capital problem in cybersecurity for all industries. Depending on what rags you read, millions of cybersecurity jobs are open worldwide at all levels. As you narrow that down to healthcare specifically, we see that a lot of the larger organizations have a CISO on staff full time. When you get to the mid- market, they probably have a person who is dedicated to security, but who has other functions as well. The organization may engage in some type of virtual information security offering to offset that, to bring in expertise and guidance without necessarily keeping somebody full time.

The big challenge is that the role turns over every couple of years. Folks do not tend to stay long in this job. That can cause challenges for the healthcare organization because they’re changing strategy every couple of years when the leader changes.

Do you have any final thoughts?

We are in an interesting time with cybersecurity and the threat landscape. I’m encouraged by the progress that most organizations are making in this space. I encourage everybody to continue to focus on the fundamentals. To those who have partnered with Fortified and our employees, thank you for driving our mission to increase the security posture of healthcare.

Morning Headlines 4/29/19

April 28, 2019 Headlines No Comments

Notification of Enforcement Discretion Regarding HIPAA Civil Money Penalties

HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

uBiome, the health start-up just raided by the FBI, had been double billing insurers

The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors.

The future of health to have new home

Arizona State University and Mayo Clinic break ground in Phoenix on the Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs.

Tech Billionaires Give $200 Million to Mass. General Hospital

InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research.

Monday Morning Update 4/29/19

April 28, 2019 News 4 Comments

Top News

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HHS announces that it will use its discretion to set maximum annual HIPAA fines based on level of culpability, reducing the amount for those with no knowledge from $1.5 million to $25,000.

Above are the old vs. new penalty tiers.


HIStalk Announcements and Requests

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Nearly 40% of a large number of poll respondents don’t see Epic, Cerner, and Meditech getting new EHR competition in the next 10 years, although 25% of respondents think Silicon Valley firms could potentially enter that market. Holly says EHRs are a dying breed with the only hope being third-party add-ons to make it all work, while Bitbot foresees data science-driven workflows that will overshadow outdated databases and processes. DrLyle takes the long view that the future entails a lot more home care, virtualization, and at-risk entities setting up clinics whose needs could be met by a slimmed-down EHR for care tasks. Matthew Holt agrees that hospitals have tied themselves to Epic and Cerner and sees the threat being that chronic care will move to the home and hospitals see their business cut back to performing procedures and attending to dying patients.

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New poll to your right or here, as suggested by a reader who is COO of a health system that is making an EHR decision and looking at vendor interoperability capabilities and federal initiatives: When will every provider in every care setting be able to reliably exchange all clinically relevant patient information? (continuity of care document, consultation notes, discharge summary, imaging integration, DICOM diagnostic imaging reports, history and physical, operative note, progress note, procedure note, and unstructured document).

I’m interested in interviewing insightful, non-vendor people who are doing work that would inspire my readers. Let me know who you recommend. Many of those I reach out to don’t have the interest, time, or organizational approval to speak frankly (and some don’t have the courage to undergo an unscripted conversation), so I’m casting the net.


Webinars

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


Acquisitions, Funding, Business, and Stock

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From the Cerner earnings call following release of quarterly results that met Wall Street expectations:

  • Chairman and CEO Brent Shafer says the involvement of activist investor Starboard Value was consistent with the company’s existing efforts to improve company financial performance.
  • Cerner has engaged turnaround consulting firm AlixPartners to look for efficiency and cost-saving opportunities that won’t negatively impact Cerner clients.
  • Key projects include looking at management structure and costs, reviewing the company’s product portfolio, rationalizing its facilities, and reviewing non-personnel costs.
  • The company will be more selective in evaluating low-margin deals.
  • Cerner will go at-risk with providers to generate higher-margin business.
  • The company notes that while the EHR market is mature, it can cross-sell revenue cycle and ambulatory products to that client base.
  • Cerner admits that companies will likely issue “competitive messaging” to Cerner’s clients about its focus on increasing margins, but says those clients needs the company to be more efficient and to bring products to market faster.
  • Asked by an analyst about the apparent de-emphasizing of the RevWorks revenue cycle management business, the company says it contributes about $200 million in annual revenue but isn’t growing, suggesting that other opportunities are more promising. It also notes that Cerner uses its Works offerings “to more tightly align the client to Cerner” for additional software and services sales and it reviews the profitability of individual clients.
  • CFO Marc Naughton notes that Cerner’s $4.5 billion Innovation Campus was completely paid for by Missouri and Kansas City tax incentives.

Meanwhile, Cerner implements a hiring freeze, telling employees that “we can do better if we target our attention on areas that represent the largest and most profitable growth opportunities and drive client satisfaction and retention.”

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The New York Times notes the sometimes clinically sloppy practices of online birth control seller Nurx, which has used unlicensed personnel to dispense medications that had sometimes been returned by other customers, told its doctors to prescribe birth control to at-risk women as long as the patient agreed, and followed the Silicon Valley mantra of asking forgiveness rather than permission. The company responded to the article by saying that those practices ended a year ago with executive replacements.

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The FBI raids the San Francisco office of UBiome, which sells questionably useful AI-powered microbiome test kits for gut health and women’s health that are ordered by its own telemedicine doctors. Reports suggest that insurers complained about being overbilled by the company, while individual customers had previously filed Better Business Bureau complaints saying that their insurance was billed thousands of dollars for tests they thought they were buying in full for less than $100. The FBI is also apparently interested in how the company pays its doctors for referrals. In an interesting twist noted by CNBC’s Chrissy Farr, UBiome’s former product VP is now CEO at Nurx (see the item above).

Tampa-based, Hearst-owned MHK (formerly known as MedHOK) moves to a new 30,000-square-foot office at Harborview Plaza this week. The company has 250 employees.

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Vocera announces Q1 results: revenue down 12%, adjusted EPS -$0.17 vs. $0.04, beating Wall Street expectations for both. From the earnings call:

  • The company had its strongest non-healthcare bookings ever in Q1, including a multi-million dollar deal with retailer Nordstrom that was triggered by a former IT person at a hospital customer site who joined Nordstrom’s IT group and suggested Vocera as a solution.
  • Provider consolidation is leading to larger deal sizes, which adds complexity to the sales and approval process, but benefits Vocera as a unified platform vendor.
  • The company is winning 70-80% of the deals it is involved with, with little competitive impact from Cerner CareAware and no effect so far from Hill-Rom’s pending acquisition of Voalte.
  • The company was awarded authority to operate with the Navy and Air Force.
  • Market acceptance of the company’s new Smartbadge has exceeded expectations.

Sales

  • SacValley MedShare HIE chooses Zen Healthcare IT as its data integration platform in the “integration as a service” model.

Announcements and Implementations

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InterSystems founder Terry Ragon and his wife Susan donate $200 million to Massachusetts General Hospital to endow a vaccine research center, piggybacking onto their $100 million donation 10 years ago to fund AIDS vaccine research. The couple, whose net worth has been estimated at $2.5 billion, has signed the Giving Pledge, in which they will give most of their assets to philanthropic causes. Terry Ragon founded InterSystems in 1978 as a vendor of the MUMPS (Massachusetts General Hospital Utility Multi-Programming System) that was invented by two eventual Meditech pioneers (Neil Pappalardo and Curt Marble) and MD/PhD student Robert Greenes (now a biomedical informatics professor at Arizona State University). MUMPS powers systems sold by Epic, Meditech, and many other health IT vendors as well as the VA’s VistA. Privately held InterSystems has since added sophisticated database, integration, HIE, and clinical systems to its portfolio for both healthcare and non-healthcare sectors.


Other

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Arizona State University and Mayo Clinic break ground in Phoenix on the 150,000-square-foot Health Futures center, which will house a medical technology accelerator, research labs for biomedical engineering and informatics, and nursing programs. The facility, which will open in 2020, will be connected to Mayo Clinic


Sponsor Updates

  • Lightbeam Health Solutions will exhibit at the BCBS 2019 National Summit April 29- in Grapevine, TX.
  • Qventus will present at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • Mobile Heartbeat will exhibit at the Trauma Center Association of America’s Annual Conference April 28-May 3 in Las Vegas.
  • Netsmart Director of Post-Acute Community Strategist Teresa Craig will speak at the 2019 Association for Home and Hospice Care of NC Expo April 29 in Raleigh.
  • Nordic will host receptions during Epic XGM on April 30 and May 7 in Madison, WI.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Michigan Section Conference May 3 in Frankenmuth.
  • T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • Redox will exhibit at Epic XGM April 29-May 10 in Verona, WI.
  • The SSI Group will exhibit at the Louisiana HFMA Annual Institute May 5-7 in Lafayette, LA.
  • Surescripts will exhibit at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.
  • The Healthcare Rap podcast features SymphonyRM Director of Client AI Chris Hemphill.
  • Wolters Kluwer Health will present at the AMIA 2019 Clinical Informatics Conference April 30-May 2 in Atlanta.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 4/26/19

April 26, 2019 Weekender No Comments

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Weekly News Recap

  • Cerner announces Q1 results that meet Wall Street’s revenue and earnings expectations
  • Seattle-based genetic testing and health coaching startup Arivale shuts down after burning through $50 million in funding
  • CPSI announces plans to acquire patient engagement vendor Get Real Health
  • Bain Capital hires financial advisors to help it assess the potential sale of RCM vendor Waystar
  • The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market
  • Athenahealth lays off 200 employees
  • HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers
  • HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment

Best Reader Comments

The EHR’s screen can be really busy and have many redundant ways of doing similar workflows. This causes some levels of frustration because various trainers or local support folks will show different ways to accomplish a task (at times it’s the incorrect / non-best practice way). I remain empathetic to my colleagues as I know that they are constantly flooded (brain blocking) from all the tech tips etc. However, I just encourage them to “make it yours” via personalization of the user interface and data entry areas a little at a time. Over a few months, they’ll find that they are recouping a few minutes a day. (Dave Butler)

I’ve not been directly involved with IBM Watson Health, but from its beginning, I have always seen Watson as a hammer looking for a nail. Not to say that it doesn’t work (I don’t know), but it is an expensive way to already do what humans do pretty well, like diagnose patients. At best, it probably is 10 years ahead of its time, before the needs and questions appear that it best answers. (Prof. Moriarty)


Watercooler Talk Tidbits

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Ms. V in Texas asked for an Apple TV for her Houston-area students — all of them English language learners and many of them living in temporary housing following Hurricane Harvey — via a DonorsChoose teacher grant request. She reports, “The Apple TV has impacted my classroom in ways I didn’t even imagine. I have seen students more engaged and excited about lessons in class. The students are eager to answer and ask many questions while learning! My students love when I use the iPad connected to the Apple TV. I am able to walk around the room while I teach. This allows me to keep an eye on student engagement as well as incorporate the students into the lesson. My students enjoy being able to show their work on the iPad as well. I have downloaded an app that allows me to put PDFs on my iPad, which include worksheets, textbooks, etc. With this app, I am able to teach from these items and students are able to write over them. It’s amazing! This technology has changed the way I teach for the better, I am so grateful for these wonderful resources!”

Wisconsin Public Radio covers the “My Life, My Story” project in which volunteers talk to hospitalized VA patients about their lives and enter their story into the EHR. One of the project’s organizers says, “”The [electronic medical] record is a mess. If you were to try to get a sense of someone’s life from that record, it might take you days.” The idea came from a VA medical resident who realized that residents rotate out of a given facility quickly, but patients in the resident clinic stay the same as they just keep meeting new doctors. A survey found that 85% of clinicians find it worth their time to read the stories of their patients to help them communicate with them as individuals.

I guess North Korea is out of network – the federal government reportedly approved paying (but apparently never actually paid) a $2 million hospital bill to gain the release of detained US citizen and University of Virginia student Otto Warmbier, who was sentenced to 15 years of hard labor for removing a hotel’s propaganda sign. It’s not exactly value-based care, either – Warmbier was returned in a coma and died shortly afterward, with a US court finding the North Korean government liable for his torture and death.

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A former pediatric resident who was fired by UK Hospital (KY) in 2017 for possessing child pornography on his work computer is charged with that crime. The Linkedin of Ryan Keith, DO extols his residency performance without noting its undistinguished end, but he has since found a career (likely not long-lasting, if I were betting, given new media exposure) as a quality associate at IV manufacturer Baxter Healthcare.

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In Australia, an ED doctor is suspended for six weeks for posting patient photos online, proclaiming that mental illness involves “the only language these people understand is the language of violence,” posting anti-gay comments, and posting explicit photos of his psychiatrist wife with the warning that a failed marriage “would end in murder.” A litany of his bizarre online commentary reveals some truly disturbing beliefs, which he says are irrelevant because he’s a great doctor.

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A 19-year-old “Instagram butt model” and “influencer” convinces a Beverly Hills plastic surgeon – himself a self-proclaimed influencer – to declare her posterior free of surgery in what she says is “the first certified real booty.” I’m torn among directing my scorn to the US healthcare system, to social media, or to those so easily “influenced” by vapid societal non-contributors. 

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An Oregon pediatrician who courts antivaxxer parents lobbies against a proposed bill that would eliminate non-medical exemptions for vaccination, all while pitching his YouTube channel, anti-vaccine book, nutritional supplements, and detox clinic.

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The local paper profiles Duke Health spinal surgeon Oren Gottfried, MD, who has earned 100 on-screen TV credits for creating medical plot lines for TV dramas and then ensuring that they are portrayed accurately. He’s about to get his first on-screen appearance on “Chicago Med.”


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Morning Headlines 4/26/19

April 25, 2019 Headlines No Comments

Cerner Reports First Quarter 2019 Results

Cerner reports Q1 results: revenue up 8%, adjusted EPS $0.61 vs. $0.58, meeting expectations for both.

Scientific wellness startup Arivale closes abruptly in ‘tragic’ end to vision to transform personal health

Seattle-based genetic testing and health coaching startup Arivale shuts down and lays off its 120 employees without warning.

28 Health Systems Commit to Transforming Behavioral Health in Hundreds of Communities Nationwide

Twenty-eight health systems join the Medicaid Transformation Project to improve the delivery of behavioral healthcare services through the use of digital tools.

News 4/26/19

April 25, 2019 News 2 Comments

Top News

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Cerner reports Q1 results: revenue up 8%, adjusted EPS $0.61 vs. $0.58, meeting expectations for both.


Reader Comments

From Vishnu: “Re: EClinicalWorks. This is the second example of the company ignoring sexual harassment. It simply relocates offenders when a problem is identified.” A Change.org petition filed by a Bangalore women’s rights organization – which should be noted to contain accusations that have not been proven as far as I know — demands that the company resolve the “indifference of the management and implicit and explicit sanction of sexual harassment” at the company’s Bangalore office. It names a company director as violating an employee who was then told that she had to “accept it in good spirit” if she planned to be promoted, had her email access turned off while on medical leave, had the person she had accused assigned to interrogate her on behalf of the company, and was threatened by the HR and legal departments before eventually being fired. 

From ATHBEL: “Re: Athenahealth layoffs. Most of the sales and some of the onboarding staff associated with the hospital product were let go. The majority of the operation staff was not eliminated. It was actually a pleasant surprise how much of the functional expertise in both product dev and support was retained and rolled into stable operating divisions within Athena. It was established with customers awhile ago that there would be no new sales or onboarding while the new ownership figured out what to do with the product. I have no idea what direction they’re taking the hospital segment and I don’t think Veritas does at this point either, honestly. The only speculation on sunsetting the product in any sort of near term is solely from competitors.” Unverified. Thanks for the info.


Webinars

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


Acquisitions, Funding, Business, and Stock

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CPSI will acquire patient engagement vendor Get Real Health for $11 million. Get Real Health saw a surge in exposure earlier this year when Microsoft suggested that HealthVault users migrate their health data to the company’s Lydia PHR.

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Seattle-based genetic testing and health coaching startup Arivale shuts down and lays off its 120 employees without warning. The company, which had raised $50 million, concluded that its annual consumer price of $1,200 to $3,500 didn’t cover the cost of performing the necessary tests. CEO Clayton Lewis also noted that Arivale wasn’t successful in convincing people that data and lifestyle changes would necessarily improve their health. Startup executives who love the idea of quantifying themselves or being paid for healthy lifestyles keeping learning an expensive lesson — they represent a tiny, navel-gazing minority whose time would be wisely spent studying their target audience as they prowl the junk food, cigarette, and alcohol aisles of Walmart while steering a wide berth around the pharmacy’s bathroom scales and blood pressure cuffs. 

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Bain Capital hires financial advisors to help it assess the potential sale of Waystar. The RCM vendor was created in 2017 from the merger of ZirMed and Navicure, which joined Bain Capital’s portfolio in 2016.

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ED software startup Vital launches with $5 million in seed funding. Developed by Mint.com founder Aaron Patzer, Vital’s technology uses predictive analytics to help ED staff identify high-risk patients, reduce wait times, and improve efficiencies.

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The FTC files an antitrust lawsuit against Surescripts for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility. It accuses the company of:

  • Requiring long-term exclusivity from customers
  • Punishing customers with higher prices if they obtain prescriptions from another company
  • Illegally pressuring Allscripts to prevent it from taking its business elsewhere
  • Sidelining RelayHealth’s ability to compete against Surescripts for six years through strict contract provisions

Sales

  • Arkansas Children’s will automate workflows and documentation into its Epic EHR and Haiku application using Excel Medical’s medical device integration software.
  • Duke Health (NC) signs a seven-year contract with Visage Imaging for its enterprise imaging software.
  • Medical transportation company LogistiCare selects call center software and services from Avaya.
  • Senior living provider Plum Healthcare (CA) will implement Netsmart’s MyUnity EHR as part of a 10-year partnership with the vendor that will involve the co-development of new senior-focused technologies and services.

People

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Jeff Macko (Revature) joins Continuum Health IT as president and managing partner.

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T2 Tech Group hires Geri Pavia (Orion Health) as VP of business development.


Announcements and Implementations

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Philips develops patient management software and companion practice management consulting services for radiation oncology departments.

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Atchison Hospital (KS) goes live on Meditech Expanse with consulting assistance from Engage.


Privacy and Security

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A JAMA-published finds that 29 out of 36 depression and smoking cessation apps transmit data to Facebook or Google, while only 12 disclose that fact in their privacy notices. The study’s authors advise that, “Users should be aware that their use of ostensibly standalone mental health apps, and the health status that this implies, may be linked to other data for other purposes, such as marketing targeting mental illness. Critically, this may take place even if an app provides no visible cues (such as a Facebook login), and even for users who do not have a Facebook account.” Facebook, meanwhile, expects to pay up to $5 billion in fines to the FTC for privacy violations.


Other

Twenty-eight health systems join the Medicaid Transformation Project to improve the delivery of behavioral healthcare services through the use of digital tools. The project’s next initiatives will focus on maternal and infant care and substance and opioid use. The project was launched last year by former CMS acting administrator Andy Slavitt and the Avia healthcare innovation network.

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A joint study between Kaiser Permanente and FDB finds that the deployment of clinical decision support for drug-disease interactions generated acceptable interruptive alerts with which clinicians agreed 92-99% of the time. Kaiser Permanente plans to implement the decision support software beyond the four regions in which it was piloted.

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Genital herpes diagnosis and treatment website HerpAlert handled 20 times its usual number cases after the Coachella music festival started, eclipsing the previous record that was set during 2018’s Oscars weekend. Patients submit photos and get a $99 doctor’s confirmation and a prescription sent to the pharmacy of their choice in an average of two hours. It’s pretty amazing that big businesses that are being built around the fact that FDA doesn’t allow over-the-counter sales of low-risk drugs for fairly obvious conditions. That business model wouldn’t work in many countries, where you can buy whatever you want from the pharmacy as a responsible adult without paying a fee to have an online doctor rubber stamp your request with a tech company taking its vig for medical matchmaking.


Sponsor Updates

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  • HCTec team members head to ThriftSmart for the company’s quarterly volunteer day.
  • EClinicalWorks will exhibit at the 2019 IPHCA Annual Conference April 29-30 in Indianapolis.
  • Ellkay will exhibit at the Executive War College Conference on Laboratory & Pathology Management April 30-May 1 in New Orleans.
  • The California Health Care Foundation features Healthfinch and its work with safety-net clinics in California.
  • InterSystems will exhibit at Epic XGM May 1-2 in Verona, WI.
  • Ivenix will exhibit at the New England Nursing Informatics Consortium Annual Symposium April 26 in Waltham, MA.
  • The “HIT Like a Girl” podcast features Kyruus CMO Erin Jospe, MD.
  • ConnectiveRx will exhibit at the Asembia Specialty Pharmacy Summit April 29-May 2 in Las Vegas.
  • Nordic unveils a new logo.
  • PerfectServe achieves certified integration with the Spectralink Versity smartphone.
  • Humber River Hospital in Toronto upgrades to Meditech Expanse.
  • Optimum Healthcare IT publishes a new infographic, “Q1 2019 Health Data Breach Report.”
  • Meditech publishes a new case study, “Kalispell Regional Advances Diabetes Management Through Patient Registries.”
  • The Arizona Hospital and Healthcare Association offers PatientPing’s real-time care alerts and context stories to member hospitals through its Affiliated Partners Program.

Blog Posts


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EPtalk by Dr. Jayne 4/25/19

April 25, 2019 Dr. Jayne No Comments

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CMS was busy this week, dropping several proposed rule changes for the 2020 fiscal year that begins in October 2019. Last Wednesday, they released a proposed rule updating Medicare payment policies for facilities that fall under the Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS). I love their language in how they explain what they are doing: “We are proposing to update IRF PPS payment rates using the most recent data to reflect an estimated 2.5 percent increase factor (reflecting an IRF-specific market basket estimate of 3.0 percent increase factor, reduced by a 0.5 percentage point multifactor productivity adjustment.” They plan to watch the numbers to see if they can further update the market basket and multifactor productivity adjustments in the final rule.

Then on Thursday, CMS released an update for the Inpatient Psychiatric Facility (IPF) Prospective Payment System and the IPF Quality Reporting program. There are more market basket adjustments to be found, including a proposal to “rebase and revise the IPF market basket to reflect a 2016 base year from a 2012 base year.” There are days that I wish I had taken more finance classes, despite spent a lot more time in the business school than my pre-med colleagues.

If you weren’t dizzy yet after those two, Friday brought proposed changes for Skilled Nursing Facility (SNF) rates. They’re proposing a new case-mix model called the Patient Driven Payment Model (PDPM) because we couldn’t possibly have had enough acronyms. The new model considers patient condition and care needs to determine payment amounts rather than the amount of care provided. As a physician, I’d think that ideally the care needs and care provided should be equal, but I suppose that’s not always the case.

The SNF rule also includes “sub-regulatory process for ICD-10 code revisions for PDPM,” which I’m sure has everyone excited. Friday’s festivities also included a proposed rule with updates for hospice payments, continuous home care, general inpatient care, and inpatient respite care per diem payment rates. Hospices that fail to meet quality reporting requirements will be hit with a 2% penalty on the annual market basket update for the year.

This Tuesday marked the release of a proposed rule to update Medicare payment policies under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The first push is for “Rethinking Rural Health,” by which Medicare plans to increase payments to so-called “low wage index” hospitals. The second set of buzzwords was “Unleashing Innovation,” which includes an increase to the new technology add-on payment when hospitals treat patients with high costs involving new technologies, such as expensive new antimicrobial therapies. As usual, CMS is accepting comments on all these proposals.

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ONC was also busy with an updated draft of the Trusted Exchange Framework and Common Agreement (TEFCA) along with a Notice of Funding Opportunity for the Trusted Exchange Framework Recognized Coordinating Entity (RCE) Cooperative Agreement.  I just liked learning a new acronym since apparently I’d been ignorant of the NOFO until now. ONC also extended the public comment period for the 21st Century Cures Act proposed rule. It’s now open for an additional 30 days and comments are due June 3, 2019.

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I’m extremely glad that influenza season is finally approaching its end, although we’re still close to December levels. My hospital logged only 15 positive flu tests this week, although other nasty bugs such as parainfluenza, rhinovirus, and enterovirus as still torturing people.

Although flu may be meeting its demise, the other big news around the physician lounge this week was the analysis that Medicare expects the hospital trust fund to be depleted in 2026. Social Security will exhaust its reserves by 2035, which is bad news for those of us who have many more years until retirement. Factors taking the blame include the rising number of beneficiaries as well as increase healthcare utilization (both volume and intensity). Until people understand what really happens in the hospital, we’ll continue to see tremendous (and often futile) expenditures in the last six months of life eating up the budget.

Arizona passed telehealth legislation this week, although it doesn’t go into effect until 2021. The new law adds asynchronous visits and remote patient monitoring to state guidelines for connected care and increases payer coverage for the services. Arizona needs all the help it can get since data shows it has one of the highest growth rates in the nation, but is near the bottom for access to primary care physicians. Arizona still prohibits audio-only telehealth calls, which I’d think would be more key to solving its issues than asynchronous communication.

Telehealth is potentially seen as a way to keep physicians in the workforce when they might retire or otherwise escape. There was a piece in the Washington Post a few weeks ago about when aging physicians should hang up their stethoscopes. During EHR implementations, I’ve run across many primary care physicians who should probably have called it quits long before the EHR ended up forcing them out. I don’t see that so much in the urgent care trenches, probably because the work is more physical and fast paced with more procedures than in a traditional primary care practice. I did enjoy one of the reader comments that most of the symptoms the article listed for potential cognitive decline “are the same as you see day to day from harried doctors who frankly aren’t paying attention.”

I saw three patients in the office today who had engaged in telehealth encounters, but weren’t getting better and had been told to seek in-person care. All three received telehealth services as an employee benefit. Two of the three had what I would consider appropriate care, but the third had a combination of medications prescribed that aren’t known to be effective for the condition for which they were given. Interestingly, none of them stated they received a copy of a care plan or any other written instructions, just prescriptions sent to the pharmacy. I was happy to steer them in the right direction with reassurance, a medication change, or an additional diagnosis.

What has your patient experience been with telehealth? Leave a comment of email me.

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Morning Headlines 4/25/19

April 24, 2019 Headlines No Comments

CPSI to Acquire Get Real Health to Expand Patient Engagement Solutions

Community healthcare EHR company CPSI will acquire patient engagement vendor Get Real Health for $11 million.

FTC Charges Surescripts with Illegal Monopolization of E-Prescription Markets

The FTC sues Surescripts for allegedly monopolizing the e-prescribing market, specifically in the areas of routing and eligibility.

Tencent-backed China online healthcare venture raises $250 million

Online Chinese healthcare company Tencent Trusted Doctors raises $250 million, bringing its valuation to $1 billion.

A machine learning device, meant to monitor the chronically ill, moves into homes

FDA approval will help move Current Health’s continuous monitoring device from the hospital setting into patient homes.

HIStalk Interviews David Wenger, CEO, Bridge Connector

April 24, 2019 Interviews No Comments

David Wenger is founder and CEO of Bridge Connector of Nashville, TN.

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Tell me about yourself and the company.

I’m the founder and CEO of Bridge Connector. Bridge Connector is an integration platform as a service with a data-driven workflow automation solution. It is focused on solving the business workflow aspect of healthcare and creating interoperability between systems and ease of communication without the need for code. It is a truly scalable platform that provides an affordable solution to any sized healthcare organization so that they can streamline their business use case workflows.

It’s unusual for someone with no healthcare or IT background to be diving deep into the technical aspects of interoperability. How did that come about?

I grew up around the medical field. My dad’s a doctor, a businessman, and an entrepreneur. I watched him my entire life and learned from him about healthcare and why it’s broken. I’m an entrepreneur. I started a marketing and advertising agency about six years ago that focused on branding, marketing, web development, and cool tasks like that. It focused on helping smaller healthcare systems, drug rehabs, and behavioral health facilities with marketing to get customers in the door as well as keep customers or patients. I learned healthcare through that.

I saw a really big problem with one of my drug rehab clients. We were hired to integrate their Salesforce instance with their electronic medical record software. They were getting 150 phone calls a day and had a full team of people in their office typing the information manually from one system to the other. It was a 30- to 45-minute process per patient. I said, we can build this integration, and it took about six months.

After we built that first integration, I thought that there must be a faster way to do this, where any of these drug rehabs or smaller healthcare organizations could connect System A to System B without having a full team of people trying to build the integration on a custom basis or manually typing the information back and forth.

My father owns a surgical center under Envision Healthcare, which is a very large company. I spoke to people at the company and learned that this is a problem across all of their surgical centers and doctor’s offices. They have no way to get the data from the doctor’s office to the surgical center, or vice versa, without having to manually type the information back and forth.

I decided to do more research and build a proof of concept. I hired some smart developers and bootstrapped the whole thing out of my own pocket with some help from some friends and family. We built and deployed a fully-functioning, working prototype. We partnered with companies like Salesforce, for example, in taking this to the masses, focusing on smaller businesses at first and scaling it from there.

Systems can talk to each other in many ways — FHIR, APIs, app stores, and traditional vendor interfaces. What are the technical and business challenges in solving the interoperability problem?

There’s a lot of standards out there, and a lot of companies that are stuck with the systems that they have. The solutions that are coming out are around API management or coding to specific APIs to build integration, so that developers have a tool they can easily use. We’ve taken a different approach. We have focused on meeting our customer at the spec their core system uses, whether it’s FHIR, HL7, API REST, SOAP, or a on-premise server solution.

We’ve created a way to connect to any type of standard and not make our customer have to code to any of those specs. We do it for them. Our platform is capable of digesting any of the types of information into one to make it a truly functioning integration. A solution like ours can go to the masses and be deployed to any type of healthcare organization, regardless of what system they’re using. As long as there’s a way to connect to that back-end system of truth or the other systems of truth, we have a way to do it, regardless of what standard they’re using.

What developments have you seen in making sure the information being exchanged makes sense to both sides and that it is inserted into the workflow at a point that makes it actionable instead of just making it available for a manual lookup?

We are focused on solving the business problems of healthcare. The problem in healthcare isn’t just clinical data. It isn’t just sending data back and forth. The problem is automating the business problem of healthcare. What drives physicians, what drives hospital organizations, isn’t just the money and patient care, but it’s automating the workflow so their daily processes can be as smooth as possible.

The government is saying to focus on interoperability. They’re trying to put a focus around it and develop it, making sure EMR companies or other vendors have fully-functioning APIs or FHIR standards. They are focused on trying to solve this problem. Companies like Bridge Connector and some of the other players out there are focused on building a standard that any sized system can easily connect to.

How do you work with traditionally low-technology, small-scale providers such as long-term care facilities and small medical practices?

We’ve partnered with the EHR companies in the long-term, post-acute care space. Their customers are requesting this type of integration and the ability to have their data flow easily. We partner at scale with a Salesforce, Clinical Care, or Brightree, for example, and provide a solution to all of their customers. The unique part about our platform is that once we build the connector or build an integration with one vendor, we’re able to rapidly deploy it again and again and again without the need for code.

Time to value, especially from a marketing brain, is everything. The faster you can go live, the better. The longer it takes, the more money the organization is losing. These smaller-sized facilities that aren’t at the leading edge of technology are trying to find ways to streamline their data so that they can solve their business workflow problem and then maximize their revenues by automation.

How does your social determinants of health functionality work?

We are launching our social determinants of health application. We’ve built a fully-functioning application on top of Salesforce. Anybody who owns Salesforce, such as a payer or large provider, can download this application that we’ve built — when it becomes available in the next month or so — and provide social determinants of health within their Salesforce org. They’re not only automating their workflow with integration and utilizing Salesforce to have all their customer data in one customer-centered place, but now they will be able to remove the barriers of care to their patients through this application that they can automatically deploy within their existing Salesforce org.

Salesforce made some healthcare-related announcements a couple of years ago, but I’m not clear what they are actually doing or who is using their product. How do you partner with them?

They are obviously a very, very fast-growing company. They have a significant interest in the healthcare space. They’re are doing a great job of providing value to the customers from a business perspective and automating that customer-patient view.

We partner with Salesforce to help the customers that they’re signing or customers that need integration. We partner with them to help automate those integrations and make them faster and make them easier to deploy, providing affordable solutions so that they can focus on what they need to focus on, which is obviously taking care of the patient.

Salesforce enables them to market to their patients and to schedule their patients. The functionality of Salesforce in healthcare is extremely impressive. We’ve been happy to partner with them and are excited to see where that goes.

What’s it like working with Salesforce, which was built on the concepts of openness and partnerships, compared to an EHR vendor?

Some EHR vendors have been slow to recognize that their customers want to be able to have the data flow as it needs to and to get the reporting that they need easily. The goal isn’t to take the data out of the EHR or make the EHR any less important to the healthcare organization. The EHR is important for the success of the business from a healthcare side as well as the patient.

The reputation of that openness of data is growing. EHR vendors are grasping the need and responding to what their customers are asking for, with integration and being able to have the data flow wherever it needs to. Obviously in keeping it secure and removing the identifiers and stuff like that. Salesforce is extremely secure. Bridge Connector is extremely secure, as well as the EHR. The core focus is taking care of the patient data and making sure it’s as protected as possible.

The company has grown quickly in headcount, customer count, and funding, but some see the healthcare IT market leveling off to some degree. How do you see that growth continuing and what will drive it?

We launched a year ago and we’ve raised $20 million so far. We had five people about 14 months ago and now we have 75 full-time employees. There’s such a need and so much customer demand for integration. Interoperability as a buzzword is more than just sending clinical data back and forth or patients having access to their medical records. The problems exist with the business use case. The markets that we’ve targeted, such as hospitals, are at the leading edge of technology.

We’re focused on the commercial space of healthcare. We are solving that business problem for those commercial vendors that can’t necessarily afford to spend money on a custom integration or developers building out integrations. They need is a rapidly deployable, affordable solution that generates immediate ROI.

We’ve grown so fast because of that, how we’ve partnered, and who we’ve partnered with. The overall need in the marketplace for a solution like what we have is driving our growth. Our growth is pretty astonishing to me, as someone who’s been here since the beginning and saw the idea and where it has taken us.

I think we are just getting started, to be honest. I think the growth will continue. We’ll continue to double in size. We’ll continue to rapidly increase revenues and customer counts and provide a solution that’s easily deployable to the masses over and over and over again, and at scale. We’re looking at hundreds of systems being rapidly deployable without the need for code over the next six to nine months. In healthcare, that solves a huge problem.

While the market might be leveling off a little bit, we think it will hit another inflection point in the next six months, where we will just continue to scale rapidly.

Do you have any final thoughts?

Healthcare is a semi-broken industry. Doctors need to focus on taking care of patients. A guy like my dad, for example, goes home every day after seeing 35-40 patients and types notes or does follow-up work on each patient. It’s an extremely draining task because of the need for notes or documentation, which are important, but there’s no way to easily do that.

The faster that the healthcare market allows for full interoperability or full connections between systems without EHRs getting in the way, from a API being available or charging customers lots of money to be able to have these integrations. As the market keeps growing, there will be a continuing need to connect systems, make the data actionable, and let the business automate workflows, Otherwise, the healthcare industry is not going to get fixed.

The way to fix it is to first solve the business problem, allowing System A, B, C, and D talk to each other. They can do that in every other industry in the world. Why can’t we do that in healthcare?

As a company that has grown as fast as we have, we feel that over the next year, we can help provide that solution to the masses. Not just hospitals, not just large enterprises, but to a small doctor’s office so their system can talk to other doctors’ offices, or have it talk to their billing system without having to go to their EHR vendor and paying thousands of dollars on top of the actual integration costs. The goal is to be able to deploy this to the entire healthcare market, not just the enterprise.

Morning Headlines 4/24/19

April 23, 2019 Headlines No Comments

Censinet Launches Industry’s First Third-Party Risk Management Platform Designed Exclusively for Healthcare Providers

Censinet launches its health system vendor management platform and raises $7.8 million in a Series A funding round.

Job cuts expected at major Belfast employer

Athenahealth will lay off about 200 employees across its offices as part of a reorganization that will integrate it with Virence Health.

Bain Considers Options for Waystar Including Sale

Bloomberg reports that Bain Capital is considering putting Waystar, the RCM vendor created from the 2017 merger of Navicure and ZirMed, up for sale.

Hartford HealthCare, Trinity, UConn to launch Hartford medtech accelerator

Hartford HealthCare will partner with Trinity College and the UConn School of Business to create a 12-week MedTech Accelerator program that will launch from Trinity’s campus this fall.

News 4/24/19

April 23, 2019 News 1 Comment

Top News

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HHS announces CMS Primary Cares, two value-based care payment models launching in 2020 that it says will cover at least 25% of Medicare beneficiaries and providers.

The models are:

  • Primary Care First, in which small primary care practices will be paid a fixed fee per patient per month, with bonuses for keeping them healthy and penalties if their patients are sicker than expected.
  • Direct Contracting, for larger practices willing to go at risk for their overall Medicare patient spending.

Reader Comments

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From Ex-Athena: “Re: Athenahealth. Laid off about 200 people today, including most of the hospital division. I think that’s a good indication of the future of the hospital product.” The company confirms that it is laying off “less than 4%” of its workforce (which would be about 200 employees) in a reorganization to integrate the former Athenahealth with Virence Health, two months after its take-private acquisition by Veritas Capital. The company did not list specific jobs or locations. Thanks to the several readers who gave me a heads up.


HIStalk Announcements and Requests

Listening: the new, final studio album from the O’Jays, which includes everything I love about exuberant 1970s-era Philadelphia soul like “Love Train” and “Back Stabbers” (smooth vocals, touches of my beloved doo-wop background harmonies, tinkly guitar riffs over horns and disco keyboards, and mellifluous talking over the music to set the scene). They still have two members of the original five after 61 years. These old guys don’t mess around in giving their fans their best – Rolling Stone notes that they rehearsed for nine weeks –seven days per week, 10 hours per day – to prepare for their Las Vegas shows. The album is great and the group deserves historical appreciation that goes far beyond simple nostalgia. This is the perfect summer music for family-friendly picnics and beach trips that will get everyone subconsciously swaying and bobbing along, the most fun music I’ve heard in a long time. It thus earns my highest recommendation.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Censinet launches its health system vendor management platform and raises $7.8 million in a Series A funding round. Founder and CEO Ed Gaudet was previously with Imprivata.

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Another reminder that US healthcare is a business – publicly traded American Addiction Centers operates call centers, a sales and marketing organization, and SEO-savvy websites that generate $22,000 annual revenue per client thanks to insurers who cover their services. They’ve been sued for leaving patients unattended who then died under their care, for which they blame short sellers of their shares. 

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Amazon begins promoting its mail order pharmacy, as powered by its $1 billion acquisition of PillPack in June 2018.

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Frances Mahon Deaconess Hospital (MT) goes live on Meditech Expanse, with consulting assistance from Engage. 


Sales

  • Cape Cod Healthcare chooses unified communications and contact center solutions from Avaya.
  • Boston Children’s Hospital will offer medical second opinions to patients in China using More Health’s collaboration platform and network.

People

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HIMSS hires its former board chair Sebastian Krolop, MD, PhD, MSc (Deloitte) as chief operating and strategy officer.

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Washington University School of Medicine names Maria Russo (Kaiser Permanente) to the newly created position of CIO.


Announcements and Implementations

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Relatient announces its Messenger two-way chat solution that allows provider staff to text patients in real time for patient engagement, making it part of its appointment reminder and broadcast messaging solution. The company notes that not only is chat the most patient-preferred communication mode, 90% of text messages from known senders are read within three minutes.

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Definitive Healthcare releases its 2019 healthcare trends survey results:

  • The most important of 2018 trend was mergers, acquisitions, and partnerships
  • The rise of healthcare consumerism was second-most important, followed by telehealth
  • Few respondents observed anything important happening with AI/machine learning, staffing shortages, cybersecurity, and EHR optimization
  • The least-important trend was wearables and remote monitoring

NYU School of Medicine researchers and the research institute that developed Siri create an algorithm that can analyze audio interviews to detect markers of post-traumatic stress disorder that elude subjective human detection. It could confirm accuracy of the diagnosis that makes up one-fifth of all VA benefits claims, but also detect veterans with PTSD who won’t admit that they have problems. Other PTSD detection research is looking at measuring stress hormones in saliva. 

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Deep users of real-time location systems urge other organizations to look beyond tracking functionality to data visibility, improved patient care, and increased efficiency, according to a new KLAS RTLS report. TeleTracking, CenTrak, and Midmark lead the pack, while Cerner and Airista Flow trail all other vendors dismally in satisfaction and actual use cases.


Other

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Financial Times profiles startups that pay patients for their digitized data, such as wearables, and then offer it to drug and device manufacturers, researchers, and FDA. The interesting aspects of these business models: (a) the information doesn’t require de-identification because the patient and data recipient sign a contract covering the terms under which it can be used; and (b) the recipient pays the patient directly.

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AliveCor’s KardiaMobile personal ECG device earns FDA indications for bradycardia and tachycardia, trumping Apple by going beyond atrial fibrillation detection.


Sponsor Updates

  • AdvancedMD publishes a new e-guide, “Pediatrics: Specialized Practice Tools to Boost Your Business Results.”
  • Former CMS leader Andy Slavitt will keynote Arcadia’s Aggregate conference April 24-26 in Boston.
  • Gartner recognizes Avaya as an April 2019 Peer Insights Customers’ Choice for unified communications.
  • Collective Medical CEO Chris Klomp will speak at the 2019 Utah State of Reform Conference April 24 in Salt Lake City.
  • Cumberland is named to Forbes’s “America’s Best Management Consulting Firms for 2019.”
  • Surescripts will exhibit at the Asembia Specialty Pharmacy Summit April 29-May 2 in Las Vegas.
  • Datica CMO Kris Gösser will speak at the Seattle Health Innovators meetup at Cambia Grove April 24.

Blog Posts


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Morning Headlines 4/23/19

April 22, 2019 Headlines No Comments

Kindbody Raises $15M Series A To Reinvent Modern Women’s Health Care

Women’s healthcare company Kindbody raises $15 million in a Series A round that brings its total funding to $22 million.

ESO Takes Over Emergency Medical Services Performance Improvement Center (EMSPIC) from the University of North Carolina

Emergency medical services software company ESO takes over North Carolina, South Carolina, and West Virginia state EMS data systems from the EMS Performance Improvement Center at the University of North Carolina.

Artificial intelligence can diagnose PTSD by analyzing voices

An NYU School of Medicine study finds that an AI tool can differentiate between the voices of veterans with our without PTSD with 89% accuracy.

Global public health expert and primary care physician to lead Ariadne Labs

Harvard professor and Brigham and Women’s Hospital primary care physician Asaf Bitton, MD succeeds Atul Gawande, MD as executive director of the university and hospital’s joint innovation center in Boston.

Curbside Consult with Dr. Jayne 4/22/19

April 22, 2019 Dr. Jayne 3 Comments

I’ve been working with a large provider group and recently spent some time with them in a retreat format. Although the group bills itself as a topnotch organization from a clinical quality perspective, there is a great deal of physician dissatisfaction. The EHR is a major target of complaints, so I was brought in to do some workflow mapping and to help facilitate the sections of the retreat where workflow topics were discussed.

It no longer surprises me, but I’m still baffled by physicians who refuse to delegate or to use their support teams to actually support them. My workflow mapping revealed the usual operational failures: 

  • Physicians doing staff-level work because they either don’t trust the staff or don’t want to spend the time educating staff on how they want it done
  • Physicians who refuse to give a year of refills to stable, compliant patients
  • Physicians who refuse to allow clinical staff to assist with refill management
  • Lack of proactive management of lab and imaging results
  • Overbooked schedules far beyond any chance of ever running on time

These are all paper problems that I suspect existed before the EHR, yet providers insist that the EHR is the reason they are working on charts at home. One physician I shadowed has his schedule blocked for 15-minute appointments, yet he consistently spends 20 to 25 minutes seeing each patient. He has a highly capable scribe and they work well together. However, he is always behind. Just doing the math, there is no way he is ever going to be able to get out of the office on time (nor will his staff) and he’s always going to have to do some work after hours. It wouldn’t matter what system he has. Until he can either figure out a way to see patients faster or is willing to adjust his schedule to match his actual cycle times, he’s always going to feel like he is under the gun.

(I suggested reducing the sports-related small talk that he engages in with every patient whether they seem interested or not, but that was met with a frosty stare from the physician, although the scribe seemed grateful for the suggestion.)

Physicians were frustrated by “missing results in the EHR” but failed to realize that it wasn’t that the results were misfiled, it was that the patient never had the tests performed. This is an issue that can be caught prior to the visit, either through pre-visit planning or an orders management process. Most of this frustration occurred when physicians were processing medication refills, which I would argue they shouldn’t be processing in the first place. They would be looking for cholesterol or diabetes labs so they could decide on whether to grant a refill or not, and were unwilling to task staff to do the hunting for them.

One physician is handling refills on his patients constantly since he won’t give them more than 90 days’ worth of refills at a time. That might be a necessary strategy for a patient whose conditions are not well controlled or who has issues with follow up, but the majority of patients can receive refills for a year without risk.

I discussed the number of organizations that successfully use refill protocols and the tools available to assist with ensuring patients are at goal before granting refills, but they felt that allowing anyone to approve refills other than the physicians themselves was “negligent.” We arrived at this conclusion halfway through the first day of the retreat, and it was all I could do to keep a straight face while I tried to figure out how I was going to get through another 12 hours with people that are not living in the real world.

We did identify a number of true EHR issues, mostly around lack of use of shortcut techniques and provider-level configurations. More than 50% of the providers I had shadowed didn’t even have favorites lists in their prescribing profiles, so they were manually searching for every single medication rather than selecting from a short list of medications that they commonly prescribe. Although providers agreed it would be beneficial to have such a favorites list, most of them said they were unwilling to create them on the fly, but instead wanted someone to build them for them either after a chart audit or through shadowing. We discussed how that could be a self-defeating strategy, because as they begin prescribing new agents or if their prescribing habits change, they wouldn’t be able to add those drugs without spending the time to explain them to a staff member or spending the time to log a help desk ticket.

We also found some issues with their CPOE system, including some confusing test names, and they were willing to come to a consensus to streamline that feature.

There were a number of issues on which we never reached resolution, but I did get to sit in on some of the sessions on non-operational topics so I could get a better feel for the culture of the group. There was an extensive review of their clinical quality metrics. Providers had previously received their reports only twice a year, but with the addition of the EHR, they began to receive them quarterly. At a previous retreat, they had asked for monthly reporting and were quite happy with it. However, it didn’t seem like anyone was willing to admit that it was only because of the “soul-sucking” EHR that they could ever have that level of transparency into their practice without spending a considerable amount of money on chart audits.

I also sat in on a financial workshop where expenses and provider compensation were reviewed. The providers weren’t terribly receptive to the CFO’s explanation that they had higher-than-market physician salaries with lower-than-average staffing costs as a possible explanation for why the physicians felt they were overworked. Unless they’re willing to shift work to team members, they’re going to be doing it at home in the evening or at times they’d otherwise prefer not to be working.

As an outside observer, it felt like the physicians were happier to spend the afternoon complaining about it rather than rolling up their sleeves and trying to find solutions since none of them were willing to take a lower salary for any reason. Although I do feel like we made some progress on a subset of quick-fix issues, I’m not sure this group is going to find its happy place anytime soon. I’m glad my role with them is limited and the engagement a short one although it was fun to be in the field after a long stretch at home.

Do you have persistent “paper problems” at your organization? Are providers willing to help address them? Leave a comment or email me.

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Email Dr. Jayne.

Readers Write: AI and Machine Learning Only Work if You Do

April 22, 2019 Readers Write No Comments

AI and Machine Learning Only Work if You Do
By Brian Robertson

Brian Robertson is CEO of VisiQuate of Santa Rosa, CA.

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Do AI and ML represent a game-changing opportunity for revenue cycle management? Absolutely. An annual research report by EMC and IDC indicates that the digital universe will contain 44 trillion gigabytes of data next year, with nearly a third of that data collected and stored by the healthcare industry, according to a Ponemon Institute study.

Within this vast ocean of data, AI and machine learning are well equipped to act as the precision sonar to detect and solve business problems using advanced data-driven methods. Indeed, AI and ML are part of today’s buzzwords du jour, but few now question that it will play a role. We must now advance the conversation: how to get going and laser in on value.

Let’s rewind to a time not long ago when we couldn’t blink without seeing a plethora of white papers on big data. They seemed to all contain the same message: “Big data has the potential to be a game-changer.” As the CEO of a company in the data analytics arena, we sometimes struggled with how to best communicate the power of big data to our clients. Our ultimate answer was to focus less on the intelligentsia and more on “get stuff done” (GSD) thinking.

Using AI and ML as an accelerator

First on deck? Don’t get too caught up in the hype cycle. From a pure technology standpoint, it’s just not that hard. One of the benefits of back-office operations, as opposed to clinical departments, is easy access and availability of structured data.

The harder part? Prioritizing business problems where a return on analytics (ROA) could deliver big value. Back to the ocean. Don’t boil it! Invest more time with your team thinking through what you’re trying to accomplish and what can deliver ROA/ROI.

Let’s take something like denial management. AI and ML can help speed up the discovery of problems that are both acute and systemic.

First, resolve what’s in front of you. Then go upstream where the real potential is. If you’re fixing the same problems repeatedly, solve that problem at its core.

Consider a physician dictation issue where some dictate with great attention to detail the complete services and care provided during a complex surgical case. Coders love that because they rely on substantive information to correctly code. That’s in contrast to physicians with less attention to detail, where denials and/or lost revenue is impacted a la the old adage, “If it wasn’t documented, it wasn’t done.”

Automating variability by physician can help you better solve problems upstream. Maybe it’s a system glitch where a bill editor is not set up correctly. Inaccurate or incomplete payer edits often repeat month after month. Deeper trending insights can automate the illustration of consistent anomalies.

This is where AI and ML become a competitive advantage, particularly when you stay focused on business value vs. the glitter of new tech. Start narrow and allow the algorithms do some of the heavy lifting.

  1. Purely repetitive process automation. Take a binary process and drive automation via robotic process automation (RPA) tools and methods.
  2. Enhance user or consumer experience. Chatbots can deliver an exceptional user experience. Why not leverage voice automation and have your chatbot send you the daily cash report for your commute home? Or a report showing slow-paying payers? Or the bad debt forecast?
  3. Deep data mining. Use anomaly detection on historical claim data to empower upstream decision-making. Leverage ML to see what’s going on with the patterns. Let the decision-making power get smarter every day.

Done right, AI and ML will improve yield, increase velocity, and optimize FTE impact.

Final tips to those looking at AI and ML for back-end optimization

  • Fail fast so you don’t lose precious time over-analyzing.
  • Avoid the technology hype and focus more on business problems the technology can help enhance or catalyze.
  • Train your staff. FTEs in repetitive roles will become obsolete — it’s just the reality of our future. We as leaders have a moral responsibility to train our talent. As Gartner often advocates, create learning pathways to enable your staff to become capable citizen data scientists. Give them a meaningful shot at surviving in the long-term.
  • Lastly, pick three business problems. Go narrow and deep. but as deep as you possibly can. Then it’s time to grab a shovel and get after it.

Morning Headlines 4/22/19

April 21, 2019 Headlines No Comments

HHS Announces Next Steps in Advancing Interoperability of Health Information

HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment.

Trusted Exchange Framework and Common Agreement – Recognized Coordinating Entity (RCE)

ONC will open a four-year, $900,000 per year funding opportunity for a non-profit to serve as the Recognized Coordinating Entity to oversee TEFCA’s Common Agreement for qualified Health Information Networks.

Latest phases at Cerner’s Innovations Campus steam ahead

Phase 3-4 construction at Cerner’s $4.5 billion Innovations Campus in Kansas City adds 777,000 square feet.

Health and education start-ups say recruiting has gotten easier in wake of Facebook, Google scandals

Startups in Silicon Valley, particularly those with a social mission, are finding it easier to recruit disenchanted talent from big tech companies like Facebook and Alphabet that have suffered from scandal-induced negative press.

Monday Morning Update 4/22/19

April 21, 2019 News 2 Comments

Top News

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HHS opens Draft 2 of its Trusted Exchange Framework and Common Agreement for public comment.

ONC will present a webinar on Draft 2 on April 23.

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In related news, ONC announces that it will open a four-year, $900,000 per year (first year) funding opportunity for a non-profit to serve as the Recognized Coordinating Entity to oversee TEFCA’s Common Agreement for qualified Health Information Networks.


Reader Comments

From Looming Clouds: “Re: health IT fire hose. Give me five things I need to know about healthcare as an outsider.”

  • Fix a problem using the most appropriate tools and methods, which may have nothing to do with technology. Companies desperately seeking a nail for their software hammer to pound always end up quietly slinking off in shame.
  • Remember that you, your friends, and your family are all patients at one time or another. You probably wouldn’t want someone like yourself affecting their care with your technology tinkering.
  • It’s tough to automate an industry whose key players (clinicians) don’t really buy into the idea of conveniently computer-amenable concepts such as evidence-based medicine, standardized practices, and reducing practice variation, especially when they are right. Medicine is half business, half science. Even those of us in the industry don’t really care which technology tools our doctors (or our accountants, or our carpenters, etc.) use – we judge them on the factors that, at best, are invisibly influenced by the technology they choose. Clinicians of all types rarely love hospital-mandated software because 80% of its functionality enforces rules set by their many overlords that add nothing to patient care and force them to enter data for someone else’s benefit.
  • People and organizations, even those in healthcare (maybe especially those in healthcare) do whatever rewards them most personally as long as they don’t have to intentionally harm patients. It’s not as ethical and purely motivated as you see on medical TV shows. Don’t be fooled into thinking that medical practices (which are always for-profit) are less nobly motivated than theoretically not-for-profit health systems and insurers. All of them will find the money no matter where Medicare and insurers hide it.
  • The only thing that matters that long-term outcomes are improved, patient access is made easier, or costs are reduced. Everything else is a nice-to-have at best. Do patients and your business a favor and find some other profit opportunity if you can’t address these issues.

HIStalk Announcements and Requests

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Two-thirds of poll respondents spend 1-3 hours each week reading healthcare and healthcare IT news, which is plenty of time to catch up on the latest news, rumors, and opinions on HIStalk (maybe 30-45 minutes of skimming per week, tops) plus whatever else is out there.

New poll to your right or here: Will Cerner, Epic, and Meditech face any new health system EHR competition in the next 10 years? If so, from whom? A lot of people (admittedly, most of them clueless) seem to think that EHRs are dinosaurs that are in imminent danger of being felled in their tracks by a Silicon Valley-launched asteroid and are planning an after-party in which a replacement product suddenly sheds all the unpleasant functionality (coding, billing, documentation) in giving clinicians a fun, rewarding system written just for their needs that will free them from the electronic shackles created by the people who provide their incomes. Those whose deep psychological insight allows them read between the lines I write might detect my skepticism.

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Thanks to Prepared Health for upgrading its HIStalk sponsorship. The company’s EnTouch Network makes it easier for patients to stay healthy at home by connecting them with providers, caregivers, and payers. Health systems use the platform to stay connected to referral sources, involve the patient’s caregivers in their care, receive real-time alerts of changes in risk or care setting, and monitor for fraud and abuse via GPS-powered visit verification. The co-founders have a long industry history going back to the early days of Medicity, which I should mention was HIStalk’s first-ever sponsor back in 2005 or so. The big company news this week is that Jefferson Health chose Prepared Health its digital technology partner for post-acute and transitional care for its 14 hospitals.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Haven opens a New York City office to attract technology talent, according to a LinkedIn post by its CTO. Open positions — which are described with just a generic job title — include clinical, data and analytics, product, and technology.

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The Kansas City business paper provides an update on Phase 3-4 construction at Cerner’s $4.5 billion Innovations Campus, with the latest efforts adding 777,000 square feet. Campus construction will be completed in 2025 with space for 16,000 employees. You have to wonder if this was a bad idea (at least in the absence of a reliable crystal ball when it was announced in 2016) given the company’s subtle retrenchment for what seems likely to be a tougher haul, which might also be true of Epic.

Several Blue Cross Blue Shield plans are sponsoring ACOs and opening their own primary care practices and urgent care centers to reduce the use of expensive hospital care.

I hadn’t checked NantHealth’s share price lately – it is $0.79, valuing the company at just $86 million and no doubt annoying those IPO-day buyers who in mid-2016 paid $21 per share (now sporting a 96% haircut). Shares of the other health IT train wreck Castlight Health are down 91% from their IPO day close in March 2014. It’s always good to remember an inviolate Wall Street rule – buying company shares early means that insiders who know way more than you are happy to dump shares on you at the price they have set.


People

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David Bean (Complete Merchant Solutions) joins Prepared Health as SVP of sales and marketing.


Announcements and Implementations

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NYC Health + Hospitals brings Epic live at 19 more locations, increasing its total to 50 and taking the $1 billion project it calls H2O past the halfway point of 45,000 users.

MDLive launches CareLink, a telehealth program that helps health plans and systems improve quality metrics via increased member engagement and lower cost. Optima Health (VA) is a pilot site.


Other

Weird News Andy will love this. An ambulance headed for a hospital ED with a patient whose heart is racing at 200 beats per minute restores normal rhythm when the ambulance hits a pothole.


Sponsor Updates

  • Formativ Health will demonstrate its Patient Engagement Platform at the NAHAM annual conference April 23-26 in Orlando.
  • Lightbeam Health Solutions will exhibit at NAACOS Spring 2019 April 24-26 in Baltimore.
  • Vyne Medical, Experian Health, and Relatient will present and exhibit at NAHAM April 24-26 in Orlando.
  • Mobile Heartbeat will exhibit at the 2019 LONE Spring Conference April 25-26 in New Orleans.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the AWHONN Colorado State Conference April 25-26 in Colorado Springs.
  • CloudWave partners with Nutanix to bring the first certified health information solution to healthcare organizations running Meditech.
  • Redox will exhibit at the AWS Healthcare & Life Sciences Symposium April 24-25 in Boston.
  • Surescripts will exhibit at Matrixcare Directions 2019 April 24-26 in Nashville.
  • T-System will exhibit at the 2019 EDPMA Solutions Summit April 28-May 1 in Scottsdale, AZ.
  • TriNetX CMO Manfred Stapff, MD publishes “First-line treatment of essential hypertension: A real-world analysis across four antihypertensive treatment classes” in the Journal of Clinical Hypertension.
  • Voalte will exhibit at the NC HIMSS Chapter Annual Conference April 23-25 in Raleigh.
  • Vocera will exhibit at the Minnesota Organization of Leaders in Nursing 2019 Spring Conference April 25 in Brooklyn Park, MN.

Blog Posts


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