A report circulated over the weekend that athenahealth CEO Jonathan Bush confessed to “numerous physical altercations” with ex-wife Sarah Seldon in 2006. 

Bush on Tuesday apologized in a statement shared with media outlets. But what’s not clear is why the report came to light now as athenahealth faces pressure from two different activist investors.  

Elliott Management, which owns 9 percent of the cloud-based EHR vendors stock, has an open $7 billion takeover offer on the table. Janus Henderson Group, athenahealth’s largest shareholder at nearly 12 percent, is publicly urging athenahealth’s board to consider a sale. 

[Also: Elliott Management ramps up pressure on athenahealth]

The healthcare technology company based in Watertown, Massachusetts, was made aware of the story on Friday by the reporter from the Daily Mail , after an undisclosed source provided the documents to the reporter, according to an athenahealth spokeswoman Holly Spring.

Athenahealth did not respond to our question on the timing of the court documents coming to light as athenahealth mulls the offer by hedge fund Elliott Management to take the organization from public to private.

“All I can tell you at this point is that the board continues to review the Elliot offer and in due course will move forward with the best next step for the company and its shareholders,” Spring said Tuesday.

Bush issued this statement on the domestic abuse allegations: “I take complete responsibility for all these regrettable incidents involving my dear former wife. They occurred 14 years ago during a particularly difficult personal time in my life when I was going through a divorce. At that time, I apologized to Sarah and took responsibility for my actions.  I have worked very hard since then to demonstrate my remorse, and today, Sarah and I have a strong, co-parenting relationship. I accept responsibility for my conduct and apologize to everyone involved.”

Bush, as is widely-known in the health IT space, is a cousin of President George W. Bush and nephew of President George H.W. Bush. 

Sarah Seldon issued this statement: “Jonathan and I have a strong, co-parenting relationship. One of respect, collaboration and love. Like many families, ours is not perfect. Neither of us are proud of the events that occurred during our divorce. This incident did happen, and is part of his and our family history, however it should not define Jonathan as a person, or our relationship overall. He is a wonderful person and father.”

And athenahealth issued its own statement as well. 

“We are aware that Mr. Bush has made amends with his ex-wife and has shown deep remorse,” the company said. “We are fully committed to a safe and respectful work environment for all our employees.”

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

King's Daughters Medical Center in Brookhaven, Mississippi, found it challenging to provide an accurate, verifiable home medication record for its providers to trust as they made important decisions about existing medications both during an inpatient visit and after discharge.

While obtaining this information may sound straightforward, the ability to actually do it can be anything but. It often involves patient interviews, communicating with families, calling pharmacies, reviewing records or a combination of these.

King's Daughters now uses external medication history from pharmacy fill data as well as insurance claims data, provided by vendor DrFirst, to complement verification and push the information to the providers. There are many medication management information systems on the market. Other vendors include Allscripts, Cerner, GE Healthcare, Genoa Healthcare, Medication Management Systems, MedMinder, Omnicell, PointClickCare, Surescripts and Talyst.

[Also: First Databank and DrFirst join forces to fight opioid crisis in Nebraska]

While it is not intended as a replacement for the patient/family interview, its integration into the electronic health record greatly augments the conversation and can prompt a patient to include easily forgotten information, said Joe Farr, RN, an emergency department nurse.

On the back-end of the visit, King's Daughters uses the e-prescription functionality in its EHR, again using DrFirst technology. This reduces the risk of prescription loss and makes the process more efficient for the patient while ensuring the health record is updated in advance of future visits, said Farr.

"The typical user is not even aware of the work in the background and it feels like native EHR functionality," he explained. That includes workflows and processes, such as interface and search functions. 

King's Daughters is required to report its performance on both medication reconciliation (with a threshold goal of 50 percent) and e-prescription (10 percent) to the Centers for Medicare and Medicaid Services.

"On our most recent reporting period, Q4 2017, our stats were 77 percent and 52 percent, respectively," Farr reported. 

Farr added that integrating medication management tech into the EHR also helped King’s Daughters more effectively retrieve historical data and deliver that information to providers to facilitate new prescriptions in a trustworthy manner that both reduces errors and the abuse of controlled substances.

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com

If your hospital or health system hasn't yet started thinking about how to handle the fundamental changes soon to arrive thanks to precision medicine, now is the time.

Before long, care and treatment based on genetic sequencing and other omic factors will become the standard of care, says one informaticist, and providers will need to be ready to compete.

"My prediction is that genomic medicine will move from a specialty that did not even require an MD degree, to become an integral part of practice that's required of everyone with an MD degree," Nephi Walton, MD, assistant professor of genomic medicine at Geisinger, said at the HIMSS Precision Medicine Summit in Washington, D.C. this month. 

Yes, it's true: Once upon a time, back when it first emerged back in the mid-1940s, medical genetics did not even require a medical degree to practice: Many of its proponents were PhDs. In the years since – especially turbocharged over the past 15 years or so, since the completion of the Human Genome Project – the science has evolved immensely.

There are many, many challenges ahead, even as genomics is increasingly prevalent. As the knowledge gained so far moves more and more into everyday care decisions, precision medicine techniques, as they currently exist, are largely inefficient and unscalable, said Walton. So big changes need to be made to capitalize on it.

Still, health systems need to be ready for this brave new world.

Geisinger is something of a unique case, of course. It's been a longtime leader in genetic-based care delivery. Not just the science itself, but its "population-approach to genomics," as Geisinger CEO David Feinberg, MD, told Healthcare IT News, screening not just sick patients but healthy ones too – something he calls "anticipatory medicine."

The success it has had so far with its MyCode initiative, with participation approaching 200,000 patients, has led the Danville, Pennsylvania-based health system to greatly expand the program. It will now start sequencing patients as routine preventative care.

But for all Geisinger's progress on this front, the larger picture of genomic medicine is one of an "overloaded system" right now said Walton: huge demand for genetic testing with a market of thousands of consumer-facing products of varying reliability; patients who misunderstand the basic premise of many of those tests; a shortage of genetic counselors, a limited supply of  clinical geneticists with more referrals than specialists.

Add to this a poor reimbursement landscape, and the problems of physician scarcity and lack of clarity – "a lot of uncertainty with classification in variants and diagnoses" – are only exacerbated.

"Why would people want to go through another two years of training to make less money, unless you're crazy like me and just love this stuff?" he said.

Right now in many places, the wait time to see geneticists can be a year or more.

"We need to spread the load to other medical professions," said Walton. "But the vast majority of physicians are not prepared to understand, deliver or manage genetic test results."

Data, data everywhere

"What we really need is to build systems that allow physicians access to quick and accurate knowledge about genetic conditions," he said. "But even that won't solve it. Because there's just no way that we can acquire and maintain the knowledge to diagnose and manage more than 10,000 diseases."

Right now, the troves of data showing genetic variants that may or may not be clinically useful are just too large and complex. And easy access to that data is lacking. ClinVar, NIH's free archive, which compiles reports on medically important variants is "a good repository," said Walton, but the fact that anyone can contribute to it means some data may be very useful but other submissions may of dubious utility.

Another more basic challenges is that the more we learn about genomic, the more complicated it all seems to get. There is a much wider phenotypic spectrum to most diseases than we thought based on the wide variety of mutations that can occur, he said. And many individuals who have unusual conditions simply have two or more overlapping variants.

Even some of the most well-studied genes, such as BRCA1 and BRCA2 don't necessarily offer a reliable path to know how treatment might be tailored. Walton showed how 22 percent of their variants might affect medical management, but 44 percent shouldn't.

Tests can be misread, and radical treatment based on a misinterpretation could pose big liability questions for hospitals, said Walton, noting that there are other more nuanced questions too

"What is the liability if you have this information (about a variant) and you don't act on it?" he said. "Or if you act on it in the wrong way? We have results that would have been classified differently, depending which lab they went to."

And what about patients' access to their own data? "Do they have the right to that, just like they do to their medical record? It's hugely valuable, but what do you do with it?"

A more immediate question is what providers do with it, said Walton. "If you go get exome sequencing done it looks at all of the expressed human genes – that generates six to eight gigabytes of crucial data."

Where does it all go? "A physician gets a PDF that might identify one variant, maybe up to three variants, that might contribute to whatever you sent the test for," he said.

"All that other data is not even used. You have tons of data that tells you how they're going to react to medications, what things they're going to have to look out for in the future, and it just doesn't go anywhere right now."

So one of the major current projects at Geisinger – especially as it embarks to make DNA sequencing its standard of care – is to work toward better integration of genomic data into the EHR for patient management and clinical decision support.

"That is going to be crucial moving forward because that is going to be the only way we're going to be able to handle this massive amount of data that's coming in," said Walton.

"I've always been critical of vendors' inability to do this, but Epic has finally put a way to store genomic data into an EHR and we're going to be going live with that in November," he added. "That is a huge accomplishment that will allow us to do decision support."

Cerner is also reportedly developing technology, in partnership with staff at Intermountain, to bring "discrete, useful, interactive precision medicine data to front-line care givers," according to a tweet from one of that health system's clinical leaders.

"People are starting to catch on," said Walton. "Now we have to figure out the decision support, the standards, how we deliver information. It doesn't matter that it's there if the provider doesn't know how to use it."

There are big questions still to be answered, he said. "As this becomes mainstream and we start pushing systems out so everyone can use it, what will they do with it? A lot of those things have to be worked out."

And it is indeed a necessity, he said. For everyone – not just clinicians, not just IT staffs, not just hospital C-suites. Stakeholders as diverse as medical schools, law firms, policymakers and patients will all need to start familiarizing themselves with these advancements.

Healthcare needs to do better safely enabling such rapid change, said Walton.

"We must embrace the genomic evolution that is taking place and find ways to enable it rather than resist the inevitable," he said.

The next HIMSS Precision Medicine Summit will take place at HIMSS19 in Orlando on Feb. 11, 2019.  

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

President Donald Trump named a new acting secretary to the Department of Veterans Affairs to replace Robert Wilkie on Wednesday because Wilkie stepped down to await his Senate confirmation hearing to permanently become the official VA Secretary. 

Yes, you read that correctly. 

The new acting Secretary, Navy and Air Force veteran Peter O’Rourke, previously served as head of the VA Accountability Office and was a member of the Trump transition team. O’Rourke took over as VA Chief of Staff in February.

In the same notice, VA Deputy Secretary Thomas Bowman announced his retirement. 

Confused? This plot is indeed hard to follow because the VA has been in constant flux since February, losing about 40 senior staffers in the last four months. 

During the same time, the VA had been holding off on its EHR modernization project -- until last week when it officially signed a deal with Cerner. 

Now, the agency has 33,000 vacancies, including 553 in the Office of Information Technology, according to a letter that 11 members of Congress signed and sent to Bowman saying that they are “deeply concerned by the malign neglect within VA’s efforts to achieve EHR modernization,” and pointing specifically to “the temporary appointment of Camilo Sandoval -- a former Trump campaign staffer -- to serve as the CIO. This appointment raises serious data security concerns stemming from Mr. Sandoval’s previous position as the Director of Data Operations in 2016 while the Trump campaign was contracting with Cambridge Analytica.” 

In a nutshell, then: With an estimated $10-16 billion in taxpayer dollars on the line, and given Department of Defense’s struggles with its own Cerner project, it’s no surprise that U.S. Senators and Representatives are seeking transparency and accountability. 

Here’s a look back at how VA leadership mix got where it is today. 

February 14, 2018
Once beloved by Trump, a scathing VA Office of Inspector General report claimed former Secretary David Shulkin, MD misused government funds to cover his wife’s airfare for a European work trip in July 2017.

The report also argued Shulkin improperly accepted tickets to Wimbledon during the 11-day trip, which was also misrepresented to ethics lawyers when Shulkin returned. VA OIG also claimed Shulkin’s Chief of Staff Vivieca Wright Simpson doctored an official email to secure the trip’s funds.

Shulkin denied all of the allegations to both OIG and the media. But Wright announced her retirement just days after the report was released.

Shulkin continued to make Congressional and public appearances amid the fallout, including discussions about his plans to partner with Cerner on the VA’s new EHR and an open API project through the agency’s Lighthouse platform.

March 16
Despite the continued turmoil, Shulkin forged ahead with his EHR modernization plans, telling Congress he was solely focused on improving the lives of veterans. Those plans included working closely with the Department of Defense to take the lessons learned from their pilot rollouts and apply them to the VA’s own Cerner project.

During this hearing, he also reiterated that privatizing the VA “would be the wrong decision for our veterans.” A stance that reportedly didn’t sit well with members of the Trump administration.

March 28
Trump officially fired Shulkin, telling the secretary just moments before he made the announcement on Twitter. The President tapped DoD leader Robert Wilkie to lead the agency in the interim, while nominating White House Physician Rear Adm. Ronny Jackson, MD to fill Shulkin’s shoes.

The move put the EHR modernization contract in limbo.

March 29
It took less than one day for Shulkin to open up about his firing to the New York Times. Shulkin claimed forces in the VA are trying to privatize the VA. While sudden staffing removals are par for the course in the Trump administration, those who leave mostly remain quiet on the topic.

Shulkin, who endured months of negative reports on his character, slammed ‘toxic’ Washington and those in the government working on personal agendas. Blaming his removal on his unwillingness to privatize VA healthcare, Shulkin said, “It should not be this hard to serve your country.”

March 30
A growing list of Congressmen and others called into question whether Trump’s nominee was qualified for the VA post. Known for his glowing report on the President’s health, his opponents shared their concerns that Jackson had never held a managerial or leadership position for a group as large as the VA.

April 4
AMVETS, one of the nation’s largest veterans’ groups, wrote a letter to Trump urging him to reconsider his choice of Wilkie for VA acting secretary. Pointing out that federal regulations predesignated VA Deputy Secretary Thomas Bowman for the position, the group argued that Wilkie’s lack of VA experience will hinder the momentum of reform underway at the agency.

April 18
The VA loses another leader as longtime acting CIO Scott Blackburn announced his departure from the agency. As one of the leaders on the EHR modernization project, it continued to put the fate of the Cerner contract in jeopardy. Blackburn had been with the VA since 2014 as an adviser to two secretaries.

Trump named his former campaigner Camilo Sandoval as the new acting CIO, which again brought further controversy. Reports claimed Sandoval conspired to get Shulkin fired, along with other reports that, as the former director of data operations of Trump’s 2016, Sandoval repeatedly clashed with staff. He was also recently accused of sexually harassing a fellow employee during the campaign.

April 26
Jackson withdrew his nomination for VA Secretary, as 23 people accused him of improper work conduct. The allegations ranged from Jackson allowing staff to write scripts for each other to give to non-beneficiaries, to crashing a government car after a Secret Service going away party.

He denied all allegations. But while he returned to the White House medical unit, Jackson was not reinstated as White House physician.

May 2
Two veterans groups sued the Trump administration and the VA for the President’s ‘unlawful’ choice for acting secretary. Citing the Federal Vacancies Reform Act of 1998, Trump didn’t have the authority to name a replacement for VA Secretary, as he fired Shulkin.

While the White House has argued that Shulkin resigned, Shulkin has repeatedly stated he would never quit his post. As a matter of law, the groups argued, deputy secretary Bowman was next in line for the position. Reports have claimed Bowman was too moderate on his views to privatize VA healthcare. The White House also denied those allegations.

May 17
Nearly a year after Shulkin announced his EHR plans, Wilkie officially signed with Cerner to modernize the VA’s EHR. But with the lawsuit calling into question whether Wilkie has the authority to do so, there may be ramifications at a later time.

May 18
Trump announced his plan to nominate Wilkie to permanently head the VA. The news was a shock, even to Wilkie, who hadn’t heard the news before Trump made the announcement at the White House summit on prison reform.

May 30
Trump once again sidesteps Bowman and selects VA Chief of Staff Peter O’Rourke as acting secretary. Wilkie stepped down to await his Senate confirmation hearing for the permanent position and returns to the DoD.

Under the Federal Vacancies Reform Act, Wilkie wasn’t legally allowed to continue in the role as: "a person may not serve as an acting officer for an office[] if ... the President submits a nomination of such person to the Senate for appointment to such office."

Bowman announced his retirement in the same notice, effective June 15. Officials said he’ll continue to serve as a consultant to the acting secretary.

Twitter: @JessieFDavis
Email the writer: jessica.davis@himssmedia.com

May might be the month for flowers but hospitals and other healthcare organizations have hardly slowed down to smell them if EHR implementations and interoperability work are any indication.

Instead, it’s been another busy one, not altogether unlike April before it. 

The biggest event, of course, came when the U.S. Department of Veterans Affairs, after much delay and the public firing via Twitter of Secretary David Shulkin, MD, officially signed the modernization contract with Cerner.

VA inked that pact as Cerner’s work with the Defense Department came under fire from an audit report for being “not operationally suitable,” after which Cerner President Zane Burke responded by suggesting that was fake news possibly.

VA and DoD are two giant EHR customers but they’re not the only ones making the rounds this month.

Capital Region Medical Center in Jefferson City, Missouri singed up with Cerner to tap its Millennium EHR as well as revenue cycle management software and other tools, as did Columbus Regional Healthcare System in Whiteville, North Carolina and Indiana Family and Social Services Administration.  

A new reality also came to light in May: EHR interoperability gets all the attention but lacking information exchange also makes rev cycle work more difficult.

More than 75 percent of respondents to a HIMSS Analytics study, in fact, said the biggest revenue cycle management challenge they face is denied claims and disparate systems are among the reasons why.

Make no mistake, though, disparate EHR systems are also causing issues all their own, notably the fact that the average hospital runs 16 distinct ones as these three charts demonstrate.

So it’s no surprise that KLAS Research found the EHR market in flux within its latest marketshare report, and pointed specifically to smaller hospitals seeking new technologies hosted in the cloud.

Holzer Medical Center in Jackson, Ohio, for instance, revealed plans to switch from Allscripts to athenahealth in late May or early June for EMR and other cloud-based services.  

Allscripts, for its part, announced that is acquiring HealthGrid at a cost of $60 million plus another $50 million in potential earn-out payments for its mobile patient engagement platform. And athenahealth’s ongoing takeover bid from activist investor Elliott Management saw its plot thicken as Janus Henderson Group, which owns 11.9 percent of the EHR maker’s stock, publicly encouraged athena’s board to consider a sale.

Indeed, all signs of a market in flux. On the higher-end, Kalorama determined that Cerner has more than double the marketshare of rival Epic.

Back on the interoperability and patient safety fronts, HIMSS posted a new free tool called the Environmental Scan of Interoperability Initiatives that hospitals (or anyone for that matter) can use to better understand connectivity options provided Epic’s Care Everywhere, Carequality, CommonWell, the Sequoia Project and others. ONC, meanwhile, kicked off its Easy EHR Issue Reporting challenge to inspire developers to create a way for clinicians to, well, report safety issues right in the EHR workflow.

Looking ahead to the future, Allscripts, Epic and others gave us a glimpse of what their next-gen EHRs will look like so here’s a hint: automation analytics, telemedicine, genomics and more.

Finally, KLAS found what the 39 hospitals already using Apple Health Records see as being the biggest areas of impact thus far and the winner is … giving patients access to their data.

It will be interesting to see whether EHR rollouts and interoperability work continue as this pace during the typically slower summer months, or not. 

Twitter: SullyHIT
Email the writer: tom.sullivan@himssmedia.com

Cardiac predictive analytics developed by Dana Edelson, MD, an expert in cardiac resuscitation at the University of Chicago, will be integrated into EarlySense's continuous monitoring tool, after the company acquired the technology.

Edelson is executive medical director for inpatient quality and safety at the University of Chicago Medicine and is the founder and CEO of Quant HC, which develops algorithms for real-time risk stratification of hospitalized patients.

Her analytics technology, called eCART, applies real-time data with a focus on prediction, prevention and treatment of in-hospital cardiac arrest – potentially leading to improved patient safety and even cost savings.

EarlySense's patient monitoring technology uses artificial intelligence to track real-time health data, including heart rate, breathing rate, sleep cycles, stress levels and movement. It analyzes heart and respiratory factors to predict cardiac arrest risk to provide early intervention.

The company has signed a deal for exclusive global rights to a version of the eCART score tool developed by Edelson. The new 'Lite' edition, unveiled at the 2018 ATS International Conference, will be integrated into EarlySense's products.

It is touted as the first-ever scientifically validated early warning score to use only heart rate, respiratory rate and patient age – well-suited for hospitals to use with continuous monitoring sensors.

"Risk scoring is a critically important tool but is currently limited to complex multi-parameter tests and lab systems found in EMR systems," said Avner Halperin, co-founder and CEO of EarlySense, in a statement. As he sees it, combining Edelson's approach with real time data enhances true deterioration detection and could save countless lives.

Edelson's eCART tool was designed to identify risk of health deteriorations and cardiac arrests based on more than 30 clinical data points per patient. It was developed using a data set of nearly 300,000 cases. The technology has already been proven to improve care in hospitals and help clinicians achieve better outcomes, including lower mortality rates.

"By working with EarlySense to adapt this hospital-proven predictive clinical score to be used with a streamlined set of data points, including continuously collected heart and respiratory parameters from the EarlySense bed sensors, we may be able to extend the predictive clinical score beyond the confines of the hospital and into post-acute and home environments,” Edelson said in a statement. "This in turn enables earlier intervention and prevention of patient deterioration and adverse events."

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

Apple has followed up on its launch of Apple Health Records at 39 health systems with the announcement today of a Health Records API, which will allow developers to create apps that can, with permission, use data from patients’ electronic health records to help people manage care, medications, nutrition, and more.

“Medical information may be the most important personal information to a consumer, and offering access to Health Records was the first step in empowering them. Now, with the potential of Health Records information paired with HealthKit data, patients are on the path to receiving a holistic view of their health,” Jeff Williams, Apple’s chief operating officer, said in a statement. “With the Health Records API open to our incredible community of developers and researchers, consumers can personalize their health needs with the apps they use every day.”

The first integration that’s been announced, for instance, is with medication tracking and adherence app Medisafe. Using the Health Records API, Medisafe users at participating health systems will now be able to import their prescription lists, making it easier to get started with the app, to set reminders, and to catch problematic drug-drug interactions.

Other use cases Apple offered up include disease management — a diabetes management app, for instance, could draw in patients’ lab data to better inform its recommendations — and nutrition, where access to cholesterol and blood pressure scores could help improve meal planning. Additional specific integrations have yet to be announced.

Finally, Apple sees the potential for further improving medical research.

“With the new Health Records API, doctors can integrate patient medical data into their ResearchKit study apps for a more complete view of their participants’ health background,” Apple wrote in a release coinciding with its WWDC developer conference. “Traditionally, researchers used arduous survey questionnaires to determine pre-existing conditions, which puts the burden on the patient to remember the details. Now, with the participants’ approval, researchers can access that patient-specific information to ensure more comprehensive research. This integration continues Apple’s commitment to providing the medical community with ResearchKit tools that could further their discoveries.”

At the WWDC opening keynote yesterday, Apple mostly shied away from healthcare, but did include a number of fitness-related announcements around the Apple Watch. Further updates on HealthKit, ResearchKit, and CareKit are expected at future sessions.

Twitter: @JonahComstock
Email the writer: jonah.comstock@himssmedia.com

Athenahealth announced Wednesday morning that founder and CEO Jonathan Bush is leaving the company and that the board will consider “strategic alternatives.”

Those include hiring a new chief executive officer as well as a “sale, merger or other transaction involving the company as well as continuing as an independent company,” athenahealth said in a statement.

Bush’s departure follows negative reports about sexual harassment, a video with lewd comments at a 2017 healthcare industry event and domestic abuse in 2006 during a divorce.

It also comes just days after an investment expert suggested that athenahealth could essentially ignore activist investor Elliott Management’s takeover bid.

Bush co-founded the cloud-based EHR, practice management, revenue cycle and population health vendor in 1997.

"I believe that working for something larger than yourself is the greatest thing a human can do. A family, a cause, a company, a country – these things give shape and purpose to an otherwise mechanical and brief human existence. Athenahealth is a near once-in-a lifetime example of such a thing,” Bush said in a statement. “With that lens on, it's easy for me to see that the very things that made me useful to the company and cause in these past 21 years, are now exactly the things that are in the way. I cannot imagine a single organization more loaded with potential to transform healthcare."

The athenahealth Board of Directors, headed by former GE CEO Jeffrey Immelt, has initiated a search process to identify qualified CEO candidates, and the athenahealth Board has initiated a search process to identify qualified CEO candidates. 

The board is working to better position athenahealth to capitalize on its healthcare technology platform, Immelt said. In the meantime, Immelt has been appointed Executive Chairman.

CFO Marc Levine will assume greater day-to-day operational responsibilities and oversight, and current board member Amy Abernethy, MD, will be advising the executive leadership team on data strategy within her role as a director, the company said.

“There can be no assurance that the review being undertaken will result in a merger, sale or other business combination involving the company,” athenahealth said. “athenahealth does not intend to make further announcements regarding the review unless and until the Board has approved a specific transaction or other course of action requiring disclosure.”

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

HIMSS has filled another new executive position with the hiring of Steve Wretling as its new Chief Technology and Innovation Officer.

Wretling, who most recently was both global chief technology officer for DaVita and chief information officer for the company's Integrated Kidney Care unit, will guide strategic enterprise-wide technology initiatives and other digital innovation projects at HIMSS.

"With more than two decades of technology and executive experience, Steve brings a broad range of technical and healthcare operations experience to his role as chief technology and innovation officer for HIMSS," said HIMSS CEO Hal Wolf in a statement. "His leadership, expertise and knowledge will help the organization drive thought leadership on technical innovation and best practices throughout the industry."  

At DaVita, Wretling worked on major initiatives such as a kidney care-focused electronic health record, telehealth and information exchange platforms, a mobile app for chronic kidney patients and more. 

He's also well-versed in critical health technology standards, having leveraged Federal Health Information Model domains and specs such as HL7 's FHIR to help drive innovation in kidney care.

Before DaVita, he spent a decade at Kaiser Permanente where he served in several positions, most recently vice president of information services for care delivery.

Wretling is third executive leader named by HIMSS in recent weeks. On May 15, it announced two big additions its international team with the hiring of Charles Alessi, MD, as new HIMSS International chief clinical officer, and Bruce Steinberg as managing director and executive vice president of HIMSS International.

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

When it comes to the challenges of raising an up-and-coming young company into a major player in its industry, former Apple and Pepsi CEO John Sculley is no spring chicken. A serial entrepreneur and investor across numerous industries ranging from consumer technology to data management to telecommunications, Sculley has set his sights on healthcare and currently serves as the chairman of hopeful PBM disruptor RxAdvance.

Speaking Wednesday in a one-on-one session at BIO18, he echoed the criticisms of others regarding healthcare’s slow adoption of new technologies and its general aversion to risky innovations. While a certain level of hesitation is understandable — especially when dealing in a regulated industry with human lives at stake — he highlighted the insular nature of many well-established healthcare players as a clear driver of the industry’s inflexibility.

“The culture in the healthcare industry is one that is largely parochial, in the sense that executives in one healthcare company may well have come from another healthcare company,” Sculley said during the session. “Invariably, when I’m inside of a healthcare company and meeting new people, and they’re meeting new people, they say “oh gee, I remember meeting you 10 years ago.” There’s a very strong bias in the healthcare industry to recruit from within the industry, and so the high-tech industry has not been a traditional recruiting ground.”

Dipping into the tech industry and will be key if healthcare is to move toward the platform-based business architectures being embraced by other sectors, Sculley said, a “fundamental” shift that he believes will have an economy-wide impact akin to industry’s adoption of factory automation in the 20th century.

“It’s just so much more efficient, so much more capable of what you can do, and incredibly less expensive, and so much innovation that is going on in platform technologies,” he said. “The people who have been building the most successful platform technologies have done it in non-regulated industries — you see the Facebooks, Amazon, Google, Apple, LinkedIn, and others. These are all non-regulated industries, and so a lot of talent is doing a lot of innovation. You come over to the regulated industries, particularly healthcare, and it’s amazing how little evidence there is of these platform technologies.

[Also: Apple unveils Health Records API for developers to build apps for platform]

“My focus has been on businesses in the healthcare sector that can take advantage of a platform as a business architecture, but you’ve got to have not just the technology background. You’ve got to have the deep domain expertise in healthcare that is so complex.”

To embrace platform-based architectures, Sculley said that the healthcare and pharmaceutical industries will need to be more willing to embrace development approaches that are commonplace in faster-moving sectors.

“The way that we build things in the high-tech industry, which has been a surprise to the healthcare industry, is that it’s done by very small teams. The original Macintosh was less than 10 people, the iPhone was less than a dozen people,” he said as an example. “When you build platforms, it’s relatively few people that are involved. But you have to be able to reimagine an industry, not just say ‘How do you do the current task cheaper?’ Reimagining industry means that you cannot look as healthcare is traditionally organized, into functions. You have to look across.”

These examples weren’t the only time Sculley described his former company. Responding to an audience question about his thoughts on consumer tech companies’ recent moves toward healthcare, he said that recent events have granted Apple a better opportunity to stake its claim than it might have expected.

“Apple has been given a chance [with the Cambridge Analytica/Facebook news, GDPR, and other recent privacy concerns] to comment how they’re different, because Apple is not interested in being in, according to Tim Cook, the business or services of selling data,” he said. “They’re interested, in the case of the iPhone and [Apple Watch], in being a device and a cloud that can be a repository for all of this information. They’re working with a number of providers around the US, enabling a place that information can be archived and information can be accessed, and obviously it’s got to be able to adhere to HIPAA rules. I suspect that’ll be a successful business for Apple over time.”

The “over time” part is key for Sculley, who made it clear that consumer tech’s move into consumer-focused healthcare won’t happen overnight. Rather, much like the rollout of Apple Pay and its gradual adoption by device owners, the company will be best served with a more patient approach, he said.

Sculley speculated that despite its healthcare aspirations, Apple would be content to leave any kind of regulated healthcare market to its competition. Here, he invoked talks of Amazon (and Jeff Bezos, whom he considers “the most talented CEO in the world) using its expertise and clout to establish itself as a tech-enabled, consumer-friendly PBM.

“My sense is it’ll be quite a few years before we see Amazon going into the high complexity of the PBM-related world,” he said, “not because they don’t understand the technology or they couldn’t scale the business, but there’s so many other low-hanging fruit they could go after, such as medical supplies or mail-order prescription drugs.”

By and large, Sculley was firm in his belief that most analysts and commentators had “gotten a little bit ahead of themselves” when predicting that Amazon and others could rock the boat within the near future — especially considering that the Amazon-JP Morgan-Berkshire Hathaway partnership has yet to find its CEO. Despite this, he said, a major shakeup in the conservative healthcare industry headed by these players is inevitable.

“I would say we’re still in early days in terms of [what] Apple and other high-tech companies are going to do in these consumer-type businesses, and even some like Amazon, who when they decide to jump into something they’ll be incredibly successful at it. But it’s inevitable; these companies are going to be getting closer and closer, and eventually they’ll be mainstream in parts of healthcare,” he said.

Twitter: @dave_muoio
Email the writer: dave.muoio@himssmedia.com

CiOX announced a new data platform, HealthSource, to help health systems meet some of the challenges of last-mile clinical interoperability. 

Company officials said the new artificial intelligence and machine learning tools power capabilities that can help providers manage the access and exchange of disparate types of health data.

The new tools come as more and more hospitals are deploying AI in novel ways. The American Medical Association, in fact, said that AI is coming to doctor’s offices and now is the time to prepare. Massachusetts General and Brigham and Women’s also just revealed plans to apply AI to both medical records and imaging, while Tampa General stood up an AI command center to streamline operations and Mount Sinai partnered with startup RenalytixAI to improve kidney disease care. And those developments just happened with the last couple weeks. 

Applying AI to the more basic problem of interoperability allows HealthSource to do two things hospitals might appreciate, according to CiOX: first enabling easier flow of health information, then helping with management of structured and unstructured records.

The HealthSource platform offers distributed, HITRUST-compliant health data exchange services, allowing hospitals to more efficiently locate and access data nationwide. Its integrated, workflow engine helps with end-to-end management and traceability of records.

The platform also offers optical character recognition software, alongside handwriting recognition and natural language processing tools to assist clinicians with digital conversion and use of unstructured data

Machine learning technology layered on top of it all allows for what CiOX calls a "continuous learning loop" for more accurate clinical data that requires less manual intervention.

CiOX has also just released other new tools to work in tandem with HealthSource – among them one called Clarity, which aims to provides transparency into the release of information process, helping hospitals get a better handle on who is requesting clinical data and enabling the secure and accurate delivery of medical records to those authorized to request them.

CiOX's new Smart Chart and Vault, meanwhile, work with HealthSource and are targeted toward payers, life science companies, government agencies and others that need access to multiple types of clinical data. Smart Chart applies AI and NLP to help extract relevant data from EHRs and aggregate it into a longitudinal digital profile; Vault allows for a central data repository. 

"Technologies such as artificial intelligence are now table stakes for digital organizations, and they are true transformative forces for the healthcare industry," said CiOX CEO Paul Roma in a statement. "We believe that when clinical data can move easily and transparently between stakeholders that the entire health system works better, and most importantly, doctors and patients benefit.”

Roma said the new suite of applications are meant to integrate "advanced and highly secured technologies into authorized medical data sharing operations," offering healthcare organizations an improvement over the "costly and obsolete way health information is accessed and consumed today."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

Athenahealth CEO Jonathan Bush is leaving the company he founded following reports of sexual harassment, a video showing Bush making lewd comments at a 2017 healthcare industry event and domestic abuse in 2006 during a divorce, the company announced Wednesday.

With its board considering “strategic alternatives,” that may include a “sale, merger or other transaction” or athenahealth will continue as an independent company. So we thought we’d ask our users: what do you think the best path forward is for athenahealth?

With athenahealth founder and CEO Jonathan Bush out of the picture, after having stepped down from the healthcare company he founded and led for 21 years, speculation about what’s next is rampant.

Bush stepped down on June 6, culminating months long-pressure from activist investing firm Elliott Partners and recent accounts of sexual misconduct involving women

Bush resigning increases the probability that athenahealth will be bought, David Larsen, an analyst at Leerink Partners, wrote in a note to clients the same day Bush exited. 

“The board will be more focused on maximizing shareholder return,” Larsen said.

For its part, Elliott said it welcomed the news that the company would consider a sale, although a statement issued by athenahealth said it could also opt to stay independent. Another option? A merger.

“We have long believed that athenahealth is a great company, and we look forward to participating as a bidder in the company’s strategic exploration process,” the investment firm said in a statement.

Elliott’s May 7 proposal would value athenahealth at $6.46 billion. Other large investors have also supported the company exploring a sale.

Piper Jaffray analyst Sean Wieland said athenahealth is still in a strong position, and expects any sale to be more than the $160 per share that Elliott has proposed.

“I think there’s better growth days ahead for the space as a whole, and in particular that there’s better growth days for athena,” Wieland stated in his memo. “They’re a disruptive software company in an industry ripe for disruption.”

[Also: Athenahealth CEO Jonathan Bush leaves, board says it will consider sale or merger]

Bush built athenahealth, based in Watertown, Massachusetts, by taking on what he called “the back-office scutwork” that relieved small hospitals and doctors to do what they do best – take care of patients.

As athenahealth considers its options and embarks on the search for a new CEO, former GE CEO and athenahealth chairman Jeff Immelt, has been appointed executive chairman. 

“To ensure athenahealth maximizes shareholder value and is best positioned to realize the full potential of its premier healthcare technology platform, the board has authorized a thorough evaluation of strategic alternatives, including a potential sale or merger or continuing as an independent company under new leadership,” Immelt said in a statement. “We approach this process with an open mind and a commitment to continuing to strengthen the company.”

Piper Jaffrey’s Wieland speculates on which companies might be best suited to acquire athenahealth. 

He suggested that as a vertical SaaS company, potential buyers are many. They include mega software companies such as Microsoft, Oracle or Salesforce. He noted that financial buyers are also keen on the company's recurring revenue and strong ability to drive incremental margins.

“We believe there will be no shortage of bidders and with a $160 bid per share from Elliott Management on the table, $160 is the downside here,” Wieland added. “We are raising our price target to $179.”

Twitter: @Bernie_HITN
Email the writer: bernie.monegain@himssmedia.com

From opioid abuse to diabetes prevention, big data is making an impact

By now, the devastating impact of opioid abuse is well-documented. The Department of Health and Human Services reports that 116 American died every day in 2016, the most recent year for which comprehensive data are available, because of opioid-related drug overdoses. More than 11.5 million people misused prescription opioids, with an estimated economic impact of $504 billion.

Conventional medical responses to the epidemic, unfortunately, have had little impact. And public policies designed to temper its wrath have proved ineffective as well. But now physicians and data scientists are teaming up to apply 21^st century tools to the crisis, and the early returns show promise.

One example comes from Scott County, Indiana, about 80 miles south of Indianapolis. Like many rural areas in America, Scott County, was only too familiar with the early ravages of the opioid epidemic. But in 2015, public officials encountered an unexpected complication: an outbreak of HIV that quickly led to more than 200 confirmed cases in a population of just 4,500 residents. With diagnoses of the deadly virus accelerating, the county turned to the Centers for Disease Control and Prevention for assistance.

To expedite its analysis, the CDC utilized Hadoop-based big data software developed by Leidos called Collaborative Advanced Analytics & Data Sharing (CAADS).

“There were a lot of things that needed to be understood,” said Ryan Weil, PhD, Leidos chief scientist, “including outbreak clusters, geographic factors, epidemiological patterns and drug resistance data.”

The system ingested heterogeneous data from county information, internal CDC data sets as well as commercial, state and local data sources and then quickly generated visualizations for high-resolution epidemiological tracing.

Because the system required no programming proficiency, Weil said, anyone could develop queries and models without coding, reducing analysis-to-insight time from weeks to hours. The reduction in time or improvement in performance has been shown to be a factor of six.

Using CAADS, public health officials confirmed the source of the issue: A specific opioid, Opana ER, had been reformulated recently to reduce abuse and was now being ground up and injected intravenously by opioid abusers who shared needles. Once HIV was introduced into the population, it quickly spread, assisted by sexual contacts.

The CAADS system used machine learning and predictive analytics to identify patient risk and generate recommendations: Declare a public health emergency, launch a public education campaign, provide substance abuse counseling and treatment, and set up syringe exchanges. The CDC was able to apply its learnings to respond to and prevent outbreaks in other vulnerable communities. And in 2017, an FDA advisory panel recommended that Opana ER be removed from the U.S. market.

While these tools proved to be of forensic value to Scott County, they are even more powerful when used to predict and prevent disease. At University of Miami Health System (UHealth), big data tools have been integrated in the system’s Epic EHR to provide physicians with predictive analytics at the point of care.

“We need a data environment that can do complex statistical analysis to help us move away from reactive medicine and toward proactive medicine, in which we get to patients before they get sick and prevent the disease from occurring,” explained David M. Seo, MD, UHealth’s chief information officer and associate vice president.

The first application of this integration is a diabetes prevention program. UHealth believes the tool will be a more effective mechanism for detecting medical risks, improving the quality of care and generating savings of up to $12.5 million as pre-diabetic patients are successfully identified and participate in diabetes prevention training.

“The next 5 to 10 years of healthcare will see a burgeoning of data ingestion, availability of data analytics, and data scientists looking for patterns and correlations,” said Leidos Health President Jonathan Scholl. “That’s going to happen, and we’re excited about that.”

Mercy, the St. Louis-based health system, is a longtime Epic client, having been on the system since 2008. But experienced proficiency with the electronic health record didn't necessarily mean they were getting the most out of it.

When it comes to harvesting data for clinical analytics, "there are a lot of things locked in the notes that we're just not able to get to," said Kerry Bommarito, manager of data science at Mercy.

Lots of information documented in the EHR – lists of specific symptoms, diagnoses derived from echocardiogram reports, certain benchmarking classifications – can offer valuable insights but aren't easily able to be accessed and analyzed.

[Also: EarlySense acquires predictive analytics to help hospitals assess cardiac risk]

For the past year or so, Mercy has been using natural language processing technology from Linguamatics to wring out lots of previously inaccessible data from seven years of clinical notes for its cardiac patients.

As part of a collaboration agreement with Medtronic, Mercy mines EHR data to evaluate heart failure device performance – letting the manufacturer know how to improve its implantable products and helping Mercy's own clinicians make better data-driven decisions on treatment.

The ongoing initiative, which tracks 100,468 chronic heart failure patients with cardiac resynchronization therapy devices, involves nearly 36 million clinical notes from both ambulatory and acute care settings.

Linguamatics' NLP technology has helped Mercy to extract key cardiology measures – ejection fraction measurement; symptoms such as shortness of breath, fatigue and palpitations; New York Heart Association classifications – and analyze them as easily as if they were discrete data sets.

Being able to make better use of the information gleaned from provider narratives is helping Mercy gaining big insights into how CRT devices can help its cardiac patients. And it hopes to put the NLP software to work on an array of other projects to help optimize its workflows and improve quality and outcomes.

"We knew we needed a tool to get elements we needed to really assess the degree of heart failure in these patients," said Bommarito.

For instance, ejection fraction – a measurement of the percentage of blood leaving your heart each time it contracts – is found in echocardiogram reports and not in the EHR's discrete fields. And symptoms such as dyspnea and dizziness often "aren't coded with diagnosis codes because they don't affect reimbursement," she explained.

The NLP software helps Mercy unlock those pieces from the clinical notes, helping that "Metronic classify these patients and also helping us use them for our own benefit to see the progression of heart failure, how symptoms change over time."

[Also: Next-gen analytics: Here's what's coming in the future]

Linguamatics offers features that make the job of mining that data and making sense of it a bit easier, said Bommarito.

"One of the biggest benefits for us was availability of their medical ontology libraries," she explained. "Instead of us having to sit here and try to come up with every single way a doctor could have said 'shortness of breath' in a note, they have these libraries: We can start our queries with the libraries, do some validation and maybe alter the query a bit so it's more tailored to the Mercy system. It's been a real time-saver.

For example, over the years, physician's preferred wording of certain symptoms might change, or documentation practices may evolve. The system is able to help account for that.

"When we do our validation on this – we're validating data for every year that we're pulling – and there are things we've noticed that were standard ways of saying things internally in 2012 that had changed a couple years later. For instance, a cardiac measurement called QRS, they changed it to QRSd. It's all about making sure you're crafting your query and making sure it evolves with the way linguistic patterns have over time."

"Our patterns of behavior and how we've used the Epic system have changed over time, as has the system itself and the technology," said Mark Dunham, director of data engineering and analytics at Mercy.

"Over the years we've added additional modules, they've come out with new features, we've upgraded, we've changed workflows," he said. But smart use of the NLP software has helped smooth over those differences and enabled the gathering of consistent data across nearly a decade's worth of record.

And it's a lot of data. The "sheer volume" meant Mercy had to "move it off of our local database and onto our Hadoop platform so we could process it a little more efficiently and feed it to the Linguamatics system," said Dunham.

But the hard work has been worth it.

"We're able to see how patients progress over time, we can see if certain treatments affect the result," said Bommarito. "If their results decline, we can see: What kind of medication are they on? Are we putting a cardiac device in them to improve their results? We're able to get at that progression of disease in the patient population and see if there are factors that affect it, or could improve it."

The Medtronic cardiac study is still ongoing, but Mercy is already planning to expand its use of NLP to other areas across the health system.

"Internally, some of the things we want to do with this are focused on physician fatigue and documentation – using NLP to help ease that," said Bommarito.

"We've talked to our primary care folks: 'Is there something we can do to help lessen the burden on pre-visit summaries, with chart reviews? Proficiencies and productivity we could gain?'" said Dunham. "There's myriad other things we can do – now it's up to us to see how we can bring this to other projects."

"Notes data has been perceived as a data desert," he said. "There's been a perceived value there, but it has always felt like there was a lot of data trapped in these notes but we weren't sure how to access it."

This cardiac project has "really opened our eyes to many possibilities as to what we can find in the note and how can it supplement what's documented there discretely," he added. "Are there opportunities to find things that could have been documented discretely and were not? And could we push them back and color in around the edges where we could get better-quality data? We're just scratching the surface of what we can do with this."

Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

After stepping down as CEO and board member this week, CEO Jonathan Bush sent an email to athenahealth employees. 

Bush resigned from the company he co-founded in 1997 amid a $6.5 billion takeover bid and allegations of domestic abuse and sexual harassment in his past. 

While Bush’s leaving might open the door for activist investor Elliott Management’s proposed acquisition, which includes a plan to take athenahealth private, thus far the EHR vendor’s board of directors has maintained that it will evaluate the offer and consider a sale, merger, or remaining an independent company. 

Bush’s departure was effective immediately. 

Here is what he sent to athenahealth employees:

Dear Friends,

Today is the last day that I will have the privilege of using that phrase, and it has been the greatest joy of my professional life – a greater joy, in fact, than I could have ever imagined. Today I am stepping down from both the board and the leadership team of athenahealth. I believe that working for something larger than yourself is the greatest thing a human can do. A family, a cause, a company, a country – these things give shape and purpose to an otherwise mechanical and brief human existence. They fill us with soul and spirit. They give us a glimpse of grace. The downside about things that are larger than ourselves, of course, is that we who have the privilege of serving them ourselves are fungible. It is the fundamental definition. You can't have the grace of the one without the other.

With that lens on, it's easy for me to see that the very things that made me useful to our company and cause in these past twenty-one years, are now exactly the things that are in our way. That's sad for me to see since I associate so much personal pleasure with working alongside my athenahealth colleagues. But it's also a joyful realization for me. Joyful, because it signifies that after all, our dear Goddess really was larger than me all this time. athenahealth really will launch beyond me, healing itself whatever wounds my own weaknesses have inflicted. Such a beautiful notion. So gratifying. Thanks to my unfailing athenahealth team, my last day at work has been fruitful. We have already gotten to work on my new life. I bought a Mac, got a Gmail account and finagled the cell number conversion law such that [his personal cell phone number] is still mine. I even have some flying lessons booked for my Instrument Rating!! Mostly though, I hope to dig into all thoughts and friendships and skills, happily put on hold these last couple decades. I look forward to seeing all of you on the sea or the street.

With all my heart, Jonathan.