5 Questions with David Freedman, DPM Foot and Ankle Specialists of the Mid-Atlantic

David Freedman, DPM is vice president of Foot and Ankle Specialists of the Mid-Atlantic (MD). The practice, which has grown from 12 to 22 locations in the last several years, employs 32 physicians and 120 staff to care for nearly 400 patients each day. As a Certified Professional Coder and American Podiatric Medical Association Coding Committee member and ICD-10 team manager, he has spoken extensively on preparing for the transition to ICD-10.

Where is FASMA with Meaningful Use? Is it working on any other healthcare IT implementations?
We participated in Stage 1 from 2011 to 2014, and are starting Stage 2 this year. With regard to other IT projects, we are adding more security, specifically encryption, to all computers and servers in 2015. The plan is to start with our servers and test some desktops. If the conversion goes smoothly, we’ll put encryption on all our computers by the end of February.

How long has FASMA been preparing for ICD-10?
We have been preparing for ICD-10-CM  dating back to January 2014. We hold monthly webinars, teaching ICD-10-CM using the website I created, www.ICDTENhelp.com. This site was developed to help in understanding the new conversion, and to get ready for our planned go-live date of October 1, 2015. It converts ICD-9-CM codes to specific ICD-10-CM coding. We have created a library of webinars that any of the billing staff, doctors, medical assistants, or staff that touches ICD-9 coding now can view on their own, besides participating in the live events.

Did FASMA purchase any new IT (or upgrade) to help with the ICD-10 conversion? If so, what type of solutions, and why?
As the developer of ICDTENhelp.com, I provided this tool to FASMA to help in its conversion. Ultimately, we have to go through the typical coding that our practice uses and remove from the database any coding that is incomplete or lacks laterality. Our EHR is GE Centricity CPS 12. This software system is ONC certified 2014.  We upgraded in 2014 to get ready for the new diagnosis system, in addition to meeting the various components for other government reporting.

Have any other IT projects had to take a back seat to your prep for ICD-10?
We currently are working to achieve both MU and ICD-10 compliance simultaneously throughout 2015. As for other projects, we are preparing to look into tablet-based patient entry versus the traditional method of completing paperwork with paper and pen.

Can you offer other physicians advice or best practices for converting to ICD-10?
It is critical that your software is ready for the switch to ICD-10-CM. Additionally, you need a resource to convert from the current ICD-9-CM, and we recommend ICDTENhelp.com. It is an excellent product that allows simplest conversion to new coding. It takes out the inaccuracies of mapping, adds the necessary dummy characters and extension codes so you do not have to add them yourself. Also, have a line of credit ready just in case there are cash flow issues with the new coding system affecting insurance reimbursement. Monitor productivity now so you can compare data to your productivity post implementation. You want to make sure to follow the processes closely after October 1 passes so this change does not affect your cash flow.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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News 2/3/15

Top News

Cerner completes its $1.3 billion acquisition of Siemens Health Services as announced in August. Cerner reiterated in the announcement that it will continue to support Siemens core systems for an unspecified period, with Soarian maintenance guaranteed for 10 years. Former SHS CEO John Glaser has joined Cerner as SVP and a member of the company’s executive cabinet. No word yet on whether he’ll accompany Cerner President Zane Burke when he rings the NASDAQ opening bell February 3.

Acquisitions, Funding, Business, and Stock

Triarq Network and gloStream – both owned by the same group of investors – merge into Triarq Health. GloStream, a health IT and consulting firm known for its gloEMR, will operate as a Triarq subsidiary called gloStream Practice Service. The new organization will supply services to help ACOs, physician organizations, and payers manage care for new pay-for-performance models.

Surescripts plans to spin off its population health business into a separate company that will operate under the Kryptiq name. Surescripts acquired Kryptiq in 2012 and will keep its secure messaging, e-prescribing, and portal technologies. Surescripts will maintain a minority ownership position in Kryptiq, which will be run by the former Kryptiq management team.

Announcements and Implementations

Dade County Medical Association (FL) selects HealthFusion as its Vendor of Choice for EHRs. DCMA, the largest county medical association in the state, will introduce HealthFusion’s MediTouch software to its 1,000+ physician members looking to implement or upgrade EHRs.

Penebscot Community Health Care (ME) chooses Forward Health Group’s PopulationManager and The Guideline Advantage.

Epic wins Best in KLAS 2014 for best physician practice vendor and several EHR/PM categories. Athenahealth wins for practice management in the two larger practice size categories (11 docs and up).

Government and Politics

ONC publishes a draft version of its 10-year interoperability roadmap that includes a short-term goal of taking actions that “will enable a majority of individuals and providers across the care continuum to send, receive, find, and use a common set of electronic clinical information at the nationwide level by the end of 2017.” Lt. Dan provides a thorough synopsis of the draft at HIStalk Connect, with extra focus on ONC’s proposed API standards for easier data exchange.

ONC National Coordinator Karen DeSalvo, MD tweets the above picture during the agency’s annual meeting. It seems she had a great time during her fireside chat with Senate Majority Leaders Tom Daschle and Bill Frist, MD.

CMS announces plans to shorten the 2015 EHR reporting period to 90 days and to change hospital reporting to be calendar year in a new rule it expects to be approved in spring 2015.

The Federation of State Medical Boards releases a fact sheet refuting what it says are six myths about its Interstate Medical Licensure Compact.

Still new Surgeon General Vivek Murthy, MD begins his House Calls Listening Tour to better understand how his office can work with organizations to improve healthcare nationwide. I’ll be interested to see how his pet causes (childhood obesity, pandemic illness, and immunization, among others) intersect with ONC initiatives given that his father was a primary care physician and his mother the practice’s manager.

New York legislators propose a one-year delay in implementing the I-STOP law that requires all prescriptions to be transmitted electronically by March 27, 2015, saying that the DEA moved too slowly in certifying vendors to transmit controlled substance prescriptions.

President Obama will propose a $215 million precision medicine initiative that includes $5 million for ONC to develop interoperability standards and privacy requirements for secure data exchange.

Research and Innovation

A study finds that “priority practices” are at increased risk for falling on the wrong side of a “digital divide” as payers and regulators enact increasing expectations for EHR use and data management. In other words, those with few resources, dwindling reimbursements, and lack of opportunity to affiliate with local health systems will find it nearly impossible to maintain the necessary expert staff and ongoing support needed to keep new healthcare technologies in good working order. One of the authors calls it a “now or never” situation: "The right solution would be to make primary care practice more financially viable, but that’s a huge system-wide undertaking in which the U.S. is far behind the curve. So we’ll resort to a duct tape fix for now, [b]ut we’d better break out that roll of duct tape pretty fast."

Researchers at UMass Medical School and Worcester Polytechnic Institute develop a smartphone app to help consumers understand why they overeat. The RELAX app will help patients track eating patterns, daily activities, exercise, mood, and stress-inducing events via smartphone. Clinicians will then be able to access the data to help patients better understand their triggers for stress eating.

Penn State College of Medicine researchers offer 10 situations that may justify a physician’s need to Google a patient. "We’re hoping that by offering scenarios that raise important ethical questions about the use of search engine technology, we can initiate a conversation that results in the eventual development of professional guidelines,” explains Maria J. Baker, associate professor of medicine. “Formal professional guidelines could help healthcare providers navigate this current ‘Google blind spot.’”

Stanford researchers use machine learning to comb through EHR data to to identify patients at risk of familial hypercholesterolemia, a condition that often goes undiagnosed until a heart attack strikes. The project, part of the larger FIND FH (Flag, Identify, Network, Deliver) initiative, is a collaborative effort involving Stanford Medicine, Amgen Inc. and the nonprofit Familial Hypercholesterolemia Foundation.

People

Helen Williams (Precision Practice Management) joins Azalea Health as director of practice management services.

Diagnotes appoints Howard Silverman, MD (University of Arizona College of Medicine), Donald Brown, MD (Interactive Intelligence), Traci Dolan (ExactTarget), Michael Mote, and Samuel Odle (Bose Public Affairs Group) to its advisory board.

Other

Health Affairs examines the current educational gaps in traditional healthcare administration and efforts underway to address them, including the Global Educators Network for Health Care Innovation Education (GENiE) Group. Born out of the Harvard Business School, the group’s 140 members are working with CEO champions like AMA’s James Madara and Athenahealth’s Jonathan Bush to make innovation a central part of the education of future leaders in healthcare.

“NrsNat” lauds the benefits of telemedicine, but calls out colleagues for “a complete lack of knowledge …  and especially administrative leadership regarding telehealth and telemedicine,” in response to the local paper’s coverage of the state of Arkansas’ growing enthusiasm for telemedicine. “Most have no idea what it is, have a hard time grasping the overall concept, and look down on telehealth nurses as incapable of doing ‘hands on nursing,’ or ‘real’ nursing work. In fact, I was told ‘it did not require any skills.’ However, Telehealth and Telemedicine require a great deal of knowledge and expertise, most companies will not hire anyone with less than 10 years clinical experience, but I hope to see much more growth and education in this area as it is extremely efficient. Patients find it especially useful.”

For Mr. H’s musical review: Canadian gastroenterologist Nejat Memiche, MD finds fame as a pop star in his native Turkey, where he also teaches medical students. His debut album, Lost in Music, was recorded in Istanbul. Should he come stateside, I’d love to see him tour with ZDoggMD.

Sponsor Updates

• Named as KLAS Category Leaders for 2014 are Emdeon (eligibility enrollment), Allscripts (global acute EMR, Northern America), and GE Healthcare (staff/nurse scheduling, time and attendance).
• Allscripts is also recognized as Best in KLAS 2014 for its global acute EMR.
• Pepper McCormick writes about the four healthcare trends that will shape 2015 in the latest Healthwise blog.
• Health IT Outcomes profiles e-MDs and its work to exchange provider data directly with the new Kansas infectious disease registry.
• Nvoq offers SayIt 9.3 with new features that simplify use and enhance organizational productivity.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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DOCtalk with Dr. Gregg 2/2/15

HIE: Finding Successes

Health information exchange (HIE) is the Holy Grail for all that is HIT. All the EHRs and self-monitoring devices and big data collection tools in the world really come to nothing if we don’t have sharing of this digitally collected data, right? What good is EHR data without data sharing? Isn’t that essentially the same as what we had before – offices and institutions filled with paper charts chock full of data with which nobody could do much of anything because it was in a gazillion different silos that had no significant interconnectivity?

To be sure, EHRs and Fitbits and other data collection tools are just as essential as the data exchange, for without them there’d be no data to be shared. But, health data collection and its sharing are like the two sides of a single coin. And a coin with but one side is just a slug.

The real purpose of Meaningful Use, Regional Extension Centers, and all that associated jazz was to drive forward a foundation upon which to build, to cast the first side of the coin, to lay the framework for the next step. That next step is the flip side of the coin, the interchange of all that collected data … sharing … true health information exchange.

Unfortunately, many of the public and semi-public HIEs, especially the broad-based and/or statewide HIE systems that were begun across the country to share said data are failing, and failing hard. (This generally excludes private HIEs created by hospitals or localized health systems that are mostly doing OK because their reason for existence is built upon a localized need and unique business model.) Without continuing grant dollars to support the public/semi-public HIEs’ less-than-capitalistic business models, many are taking a nosedive, likely into oblivion.

And, to be honest, that was the intention.

No, the intention wasn’t to create a bunch of money-sucking, doomed-to-fail exchanges. The intent was to create the growth medium, a nationwide test bed if you will, for deriving a few winners, a few flowering models of success among the weeds of failure. At least that’s what I was told back in the early days of HITECH and RECs and MU by one of those so-called “highly placed governmental sources.” He (or she) said that the feds knew that many a Regional Extension Center and/or HIE would essentially fail, that most would survive only as long as the soft money lasted. They knew that they were generating a bunch of loss leaders, so to speak, but also knew – or at least hoped – that a few successes would blossom. The goal was to create a sufficiently fertilized environ to generate a few winners, a few role models that could hopefully be cloned and replanted atop the tilled-under graves of those expected-to-die organizations. (Personally, I can’t verify the truth of that thought process or say whether those intentions were ever spoken openly amongst the feds, but it does seem fitting with what has transpired since.)

If that broad “test bed” model was in fact true, it’s those successes it engendered upon which the whole future of HIE depends. If those so-far-proven models continue to thrive, and if they can be extended or replicated across the rest of the country, and if they can execute successful inter-HIE connectivity just as successfully as they did within their own intra-HIE networks, then a true national “Holy Grail” health information exchange might be realized.

Healthcare Informatics recently ran a piece entitled “Top Ten Tech Trends: "Survivor: Edition HIE"– Can Statewide HIEs Achieve Sustainability?” that briefly discussed a few of the successful HIEs – those in Colorado, Maine, Michigan, and Ohio. To get a flavor of the blossoms that are growing from the federal HIE garden, it’s worth the read. (Full disclosure: I’m on the board for the Ohio HIE, Clinisync. Also, the article quotes Clinisync’s CEO, Dan Paoletti, a friend and one of the finest human beings I’ve ever known, so I’m probably biased in my recommendation of this read.)

Who knows what the final nationwide HIE will eventually look like? But, it is coming. Many might say it’s premature, but I believe the tipping point has passed and we’re now on the uninterruptible path toward true and total health information exchange. It may seem like it is a ways off, but I’m betting the Holy Grail is closer than most people think.

From the trenches…

“If you have no critics, you’ll likely have no success.” – Malcolm X

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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News 1/29/15

Top News

CVS Health announces clinical affiliations with the LSU Health Network (LA) and Shawnee Mission Health (KS). LSU and Shawnee patients will have access to clinical support, medication counseling, chronic-disease monitoring, and wellness programs at CVS/pharmacy stores and MinuteClinics. CVS Health, in turn, will provide prescription and visit data to the health systems via EHR and information systems integration. In addition, physicians affiliated with the participating health systems will collaborate with MinuteClinic nurse practitioners to work closely on joint clinical programs and care coordination activities.

HIStalk Practice Announcements and Requests

Several HIStalk team members have enjoyed sunny skies for most of this week, while others have experienced the hopefully waning Northeastern blizzards first-hand. No matter the conditions, the HIStalk sites continue to publish faithfully, knowing that many of our readers are working tirelessly from home even though their offices may officially be closed. It strikes me as a bit sad that today’s workforce no longer has the luxury of taking adult snow days. Jesse Singal of New York Magazine explains his snow-day discontent rather eloquently: “In a world that forces us to inhabit our roles as workers ever more intimately — one in which time actually off from work has been shrinking for decades, where it’s easy to forget that there’s more to life than what it says on our business cards — snow days were one of the few remaining excuses not to be a worker for a little while. I’m going to miss them, even if I haven’t really had much time to think about it.”

Announcements and Implementations

Atlanta-based Premedex launches its Chronic Care Management Solution Suite to help physician practices more efficiently manage the operational and financial tasks associated with caring for patients with chronic diseases.

Quest Diagnostics partners with the CDC to improve hepatitis diagnosis and treatment. As part of the collaboration, Quest will provide CDC researchers with access to its Health Trends database of de-identified clinical testing hepatitis data. A primary goal will be to identify and monitor trends in hepatitis B and C viral infection in pregnant women, and to characterize those patients by demographics and type of physician.

PatientPoint partners with Ion Solutions to offer its PracticeWire and Exam Room Tablet education and engagement solutions to Ion’s national network of oncology practices.

Eastern Idaho IPA chooses Valence Health’s vElect contract administration system to allow physicians to compare fee schedules to Medicare benchmarks in selecting and declining payer contracts.

MedConnect selects clinical interface terminology from Intelligent Medical Objects for its EHR.

Georgia’s GRAChie HIE – founded by Cerner, GRHealth, and Navicent Health — reports increased numbers of data sources and system usage.

The Apple Watch will begin shipping in April, perhaps just in time for HIMSS giveaways. It will be interesting to see how many Apple fans pony up $349 for the privilege of standing in line at Apple stores on the as-yet-unspecified date. Surely it won’t be on April 15.

Acquisitions, Funding, Business, and Stock

Portland, OR-based Clinicient secures $7 million in debt funding from Silicon Valley Bank. The line of working capital will be used to enhance its EHR, PM, and revenue cycle solutions for outpatient rehabilitation therapists.

Government and Politics

New CMS data reveal that only 15 percent of eligible providers have attested for Meaningful Use Stage 2. Of those, 47 percent did not actually meet Stage 2 in 2014, but instead took advantage of a hardship exemption and attested to Stage 1. The majority of that group used EHRs certified in 2011, while 28 percent used 2014-certified EHR technology.

Health insurance exchange enrollees total 9.5 million, a good bit above the administration’s hoped-for goal of 9.1 million. That number still has opportunity to climb with 18 more days to go until the February 15 enrollment deadline. Florida and California have led the pack, with a total of 2.5 million citizens enrolled.

Speaking of government services, the American Customer Satisfaction Index shows that the nation’s satisfaction with federal government services continues to decline. This year’s score of 64.4 is the lowest it’s been since the Index was first published in 1999. HHS had its second consecutive decline in citizen satisfaction, falling from 69 in 2012 to 62 in 2014. Only Internet service providers scored lower than the government when compared to other verticals.

Other

Good news for quantified selfers, and telehealth and wearables fans in the Southeast: Google Fiber is coming to Atlanta, Nashville, Charlotte, and Raleigh-Durham within the next 18 months. They are among the nine cities Google announced nearly a year ago as being considered for the gigabit fiber-to-the-home service. It’s worth noting that Georgia and Tennessee have legislated parity for private coverage of telemedicine services, according to the American Telemedicine Association, while North Carolina doesn’t seem to have taken up the issue.

The local paper highlights Avhana Health, a Baltimore-based startup focused on building a better electronic checklist for physicians. After graduating from the DreamIt Health Incubator last year, the company went on to work with the HHS Office of Population Affairs testing integration standards. It’s now looking to test its system with physicians.

Fast Company sheds light on the intersection of corporate wellness programs and precision medicine, ultimately concluding that targeted initiatives fueled by analytics are the key to creating healthier employees and reducing corporate healthcare expenses.

Sponsor Updates

• Clockwise.MD is nominated as a finalist in the inaugural Georgia’s Top Startup Awards.
• Jaffer Traish of Culbert Healthcare Solutions writes about data sharing.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

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News 1/27/15

Top News

HHS Secretary Sylvia Burwell unveils a new plan and timeline for moving healthcare providers from a fee-for-service model to a value-based reimbursement model. Goals include getting 50 percent of all Medicare provider payments switched over to alternative payment models by 2018, and for nearly all Medicare fee-for-service payments to be tied to quality and value by the same year. Burwell also announced the formation of the Health Care Payment Learning & Action Network, calling on providers, consumers, employers, payers, industry, and other government agencies to help HHS keep to its aggressive timelines.

Acquisitions, Funding, Business, and Stocks

New Jersey-based MaxMD receives clearance from the Minnesota Department of Health to operate as a Health Data Intermediary in the state, meaning that providers there now have access to its Direct Messaging services. (On a whim, I looked up Minnesota’s state motto. “L’etoile du Nord” dates back to 1861, though “the Land of 10,000 Lakes” is far more well known.)

This article digs into telemedicine company Doctor on Demand’s revenue model, breaking down the cut it takes from patient fees and employer utilization. The San Francisco-based company also brings in revenue from its white-label offering for health systems. Given that it raised $21 million late last year, I’ll be interested to see how its MGMA booth compares to its HIMSS booth.

Emdeon is considering an IPO, sources say. The earnings multiples of recent sector deals suggest a valuation of $5.4 to $6.6 billion, which would create huge profits for the two private equity firms that took Emdeon private in 2011 for $3 billion.

The local business paper profiles the healthcare technology investment plans of GE Ventures, which has 17 healthcare-related companies in its portfolio. The firm typically invests in five HIT companies each year, to the tune of between $3 million and $8 million apiece. “The sort of companies we’re looking for are divided into three verticals across health care,” explains Alex de Winter, director, “Minimally invasive medical devices, healthcare IT and services and precision medicine, which got a shoutout from Obama, clinical diagnostics, and life sciences instrumentation.”

Announcements and Implementations

Three-hundred fifty Kaiser Permanente ambulatory clinics receive the Stage 7 Ambulatory Award from HIMSS Analytics. The award recognizes the organization’s use of its HealthConnect EHR, the largest non-governmental EHR in the world.

Florida Cancer Specialists & Research Institute selects Athenahealth’s revenue cycle and PM services as part of a pilot program in which the new technology will be rolled out in phases to 300 providers.

Community Eye Center Optometry (CA) selects the VersaSuite EHR and PM system.

EHNAC announces new versions of criteria for 15 accreditation programs. Applicant candidates beginning the accreditation process in this year will adhere to the updated criteria versions for accreditation and/or re-accreditation.

Government and Politics

CMS adds star ratings to its Dialysis Facility Compare website. The annually updated ratings summarize performance and quality, joining similar rating systems used for Physician Compare and Nursing Home Compare.

Telehealth already seems to be the healthcare business buzzword of 2015, and we’re only 27 days in. The Federation of State Medical Boards launches LicensePortability.org to track the progress of the Interstate Medical Licensure Compact in state legislatures. (Nine states have already introduced it this year.) Originally introduced in September 2014, the compact proposes legislation that would speed up the process of issuing licenses for physicians who wish to practice in multiple states, in turn making it significantly easier for telemedicine companies to operate to their fullest potential.

Teladoc continues to make news as its services get shut out of Texas and Arkansas due to medical board concerns over patient-physician relationships. The company, based in Dallas of all places, went so far as to sue the Texas Medical Board (for the second time) for its declaration earlier this month of an emergency rule requiring physicians to meet patients "face-to-face" before prescribing them a controlled drug. “There is no imminent peril,” the company’s complaint states. “There is no emergency. There is only a state agency ignoring its legal limitations in a blatant attempt to get its way.” Teladoc does not operate in Idaho for similar reasons.

The state of Colorado’s House Health, Insurance, and Environment Committee approves a bill that would expand the use of telemedicine across the state. If approved, the bill would prevent payers from requiring in-person care if consulting, monitoring, and other care could be as effectively administered at a distance.

HRSA Administrator Mary Wakefield, RN tours the South Dakota facilities of telemedicine network Avera, which provides remote care to rural populations via its growing e-Care network. “We have so many parts of the United States that are under served,” explains Wakefield, “that are what we call health profession shortage areas. [Avera e-Care] is, over time, part of the solution I think to that problem.”

HHS reduces the outbound flow of personal consumer data from Healthcare.gov to third-party sites, caving to public outcry over the revelation that the exchange was delivering personal registrant details including age, ZIP code, and income to websites related to advertising, and data mining for marketing and performance metrics. The agency had previously contended that the outside companies used the data only to analyze and improve Healthcare.gov.

Research and Innovation

The American Society of Clinical Oncology partners with SAP to develop CancerLinQ, a computer network that will help cancer doctors make treatment decisions for their patients based on the outcomes of comparable patients. ASCO expects to roll the first version of CancerLinQ out by the end of 2015 to 15 oncology practices that are contributing half a million patient records to the big data project.

This article highlights the parameters the VA has set around its two-year, $16 million Watson pilot project. They include initially operating in a safe-harbor environment where simulated patient encounters will be run using real clinical data, assessing the ability of the system to perform clinical semantic searches of the EHR and clinical literature, and assessing its ability to generate problem lists from the EHR.

Other

Silicon Valley-based Doximity launches an interactive map highlighting physician compensation trends and salaries across 48 specialties, plus potential career opportunities in rural areas with shortages. Dr. Jayne, who seems to be considering career options at the moment, may want to think about going rural: Doximity data indicates that physicians in rural areas see an average of $1,500 more in salary each year compared to those in urban areas.

Those interested in historical clinical career data may want to check out ONC’s updated Health IT Dashboard, which now includes state and county estimates for the number of MDs, PCPs, NPs, and PAs from 2011 to 2013.

Sponsor Updates

• Healthwise wins gold and silver Web Health Awards for its health education videos.
• E-MDs CEO David Winn pens a new article entitled, “Time to Let the Air Out of the Tires on ICD-10.”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis

More news: HIStalk, HIStalk Connect.

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