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Wellness and Patient Centered Care – Fun Friday

Posted on June 22, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s time for the weekend, so let’s get your weekend started off right with some healthcare humor. This first cartoon explains a lot about our healthcare problems today. Although, in 2018 the device is even smaller.

This one is sad and funny. It definitely illustrates how many times we have to work on our definitions of patient centered care. I’ve found that the first step in that is talking with more patients.


MD Anderson Fined $4.3 Million For HIPAA Violations

Posted on June 21, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

An administrative law judge has ruled that MD Anderson Cancer Center must pay $4.3 million to the HHS Office of Civil Rights due to multiple HIPAA violations. This is the fourth largest penalty ever awarded to OCR.

OCR kicked off an investigation of MD Anderson in the wake of three separate data breach reports in 2012 and 2013. One of the breaches sprung from the theft of an unencrypted laptop from the home of an MD Anderson employee. The other two involved the loss of unencrypted USB thumb drives which held protected health information on over 33,500 patients.

Maybe — just maybe — MD Anderson could’ve gotten away with this or paid a much smaller fine. But given the circumstances, it was not going to get away that easily.

OCR found that while the organization had written encryption policies going back to 2006, it wasn’t following them that closely. What’s more, MD Anderson’s own risk analyses had found that a lack of device-level encryption could threaten the security of ePHI.

Adding insult to injury, MD Anderson didn’t begin to adopt enterprise-wide security technology until 2011. Also, it didn’t take action to encrypt data on its devices containing ePHI during the period between March 2011 and January 2013.

In defending itself, the organization argued that it was not obligated to encrypt data on its devices. It also claimed that the ePHI which was breached was for research, which meant that it was not subject to HIPAA penalties. In addition, its attorneys argued that the penalties accrued to OCR were unreasonable.

The administrative law judge wasn’t buying it. In fact, the judge took an axe to its arguments, saying that MD Anderson’s “dilatory conduct is shocking given the high risk to its patients resulting from the unauthorized disclosure of ePHI,” noting that its leaders “not only recognized, but [also] restated many times.” That’s strong language, the like of which I’ve never seen in HIPAA cases before.

You won’t be surprised to learn that the administrative law judge agreed to OCR’s sanctions, which included penalties for each day of MD Anderson’s lack of HIPAA compliance and for each record of individuals breached.

All I can say is wow. Could the Cancer Center’s leaders possibly have more chutzpah? It’s bad enough to have patient data breached three times. Defending yourself by essentially saying it was no big deal is even worse. If I were the judge I would’ve thrown the book at them too.

Exec Tells Congress That New Health Data Threats Are Emerging

Posted on June 20, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A senior security executive with a major academic health system has told Congress that in addition to attacks by random attackers, healthcare organizations are facing new threats which are changing the health security landscape.

Erik Decker, chief security and privacy officer with the University of Chicago Medicine, testified on behalf of the Association for Executives in Healthcare Information Security in mid-June. He made his comments in support of the reauthorization of the Pandemic and All-Hazards Preparedness Act, whose purpose is to improve the U.S. public health and medical preparedness for emergencies.

In his testimony, Decker laid out how the nature of provider and public health preparedness has changed as digital health technology has become the backbone of the industry.

He described how healthcare information use has evolved, explaining to legislators how the digitization of healthcare has created a “hyper-connected” environment in which systems such as EHRs, revenue cycle platforms, imaging and ERP software are linked to specialty applications, the cloud and connected medical devices.

He also told them about the increasing need for healthcare organizations to share data smoothly, and the impact this has had on the healthcare data infrastructure. “There is increasing reliance on these data being available, and confidential, to support these nuanced clinical workflows,” he said. “With the adoption of this technology, the technical ecosystem has exploded in complexity.”

While the emergence of these complex digital health offers many advantages, it has led to a growth in the number and type of cybersecurity problems providers face, Decker noted. New threats he identified include:

* The development of underground markets and exchanges of sensitive information and services such as Hacking-as-a Service
* The emergence of sophisticated hacking groups deploying ransomware
* New cyberattacks by terrorist organizations
* Efforts by nation states to steal intellectual property to create national economic advantages

This led to the key point of his testimony: “We can no longer think of preparedness relative only to natural disasters or pandemics,” Decker said. “It’s imperative that we acknowledge the criticality of cybersecurity threats levied against the nation’s healthcare system.”

To address such problems, Decker suggests, healthcare organizations will need help from the federal government. For example, he pointed out, HHS efforts made a big difference when it jumped in quickly and worked closely with healthcare leaders responding to WannaCry attacks in mid-2017.

Meanwhile, to encourage the healthcare industry to adopt strong cybersecurity practices, it’s important to offer providers some incentives, including a financial subsidy or safe harbors from enforcement actions, he argued.

5 Steps to Ensure Revenue Integrity After Implementing a New EHR

Posted on June 18, 2018 I Written By

The following is a guest blog post by Lisa Eramo, a regular contributor to Kareo’s Go Practice Blog.

In the rush to implement EHRs for Meaningful Use incentives, many practices lost sight of what matters most for continued success—revenue integrity, says Joette Derricks, healthcare compliance and revenue integrity consultant in Baltimore, MD. Revenue integrity—the idea that practices must take proactive steps to capture and retain revenue—isn’t a novel concept. However, it’s becoming increasingly important for physician practices operating in a regulatory-driven environment, she adds.

Revenue integrity is also an important part of ensuring smooth cashflow during and after the transition to a new EHR, says Derricks. This is a time when revenue opportunities are easily overlooked as practices adjust to new navigation, templates, and more, she adds.

Revenue integrity is all about compliance, says Derricks. “It’s about taking a holistic approach to operational efficiency, regulatory compliance, and maximizing reimbursement,” she adds. “It’s about doing things the right way.”

Maximizing reimbursement isn’t about ‘gaming’ the system to upcode. Rather, it’s about implementing processes and procedures to ensure that practices are paid for all of the services they perform without leaving money on the table or generating revenue that payers will later recoup, she explains.

Derricks provides five simple steps practices can take to ensure revenue integrity following an EHR implementation:

1. Review EHR templates. Do templates include the most specific CPT and ICD-10-CM codes? And do physicians understand the importance of avoiding unspecified codes, when possible?

2. Examine the interface between the EHR and practice management system. Do the codes that physicians assign in the EHR feed correctly into the practice management system? For example, when a physician performs an E/M service in addition to a procedure, does the EHR map both codes to the practice management system for billing purposes? Does the practice management system correctly bundle and unbundle services, when appropriate?

3. Run your numbers frequently. Ideally, practices will perform a monthly data analysis to help gauge performance and identify potential missed revenue opportunities, says Derricks. For example, she suggests running a report of the practice’s top 20 billing codes in a particular month. Then, compare those codes with the top 20 codes the practice billed that same month in the previous year. What has changed, and why? And have these changes benefited or hurt the practice? For example, practices may see new codes in that list because they added chronic care or transitional care management, both of which provide additional revenue. Or practices may discover a system glitch that incorrectly bundled services that are separately payable, thus causing a revenue loss.

“Everybody can play the ‘I’m too busy’ game, but this is too important to fall into that trap,” says Derricks. “I applaud the office manager or practice administrator who recognizes the value of constantly being on the lookout for system-wide improvements and analyzing their own numbers.”

Some practice management systems provide robust billing analytics that can help practices identify the root cause of billing errors and omissions. Working with a consultant is another option, says Derricks. Consultants provide unbiased input regarding inefficiencies and vulnerabilities and can provide a ‘fresh set of eyes’ necessary to effect change. They also often have access to benchmarking tools and other resources that can help practices identify revenue gaps and delays, she adds.

For example, Derricks suggests performing an assessment for revenue gaps and roadblocks to reduce the workflow process errors that delay revenue. Download the assessment.

4. Provide physician training. Physicians need thorough training on how to use the EHR properly so as to avoid data omissions, says Derricks. They also need annual training on new CPT and ICD-10-CM codes as well as new documentation requirements, she adds.

5. Create an environment that promotes compliance. This requires a top-down approach from physicians and practice managers, says Derricks. “Everyone should have their eyes open and feel comfortable being able to address concerns,” she says. “It should be an open-door policy in terms of looking at processes versus putting your head down.”

About Lisa Eramo
Lisa Eramo is a regular contributor to Kareo’s Go Practice Blog, as well as other healthcare publications, websites and blogs, including the AHIMA Journal. Her focus areas are medical coding, clinical documentation improvement and healthcare quality/efficiency.  Kareo is a proud sponsor of Healthcare Scene.

Stanford Survey Generates Predictable Result: Doctors Want EHR Changes

Posted on June 11, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I know you’re going to have trouble believing this, but many PCPs think EHRs need substantial changes.

Such is the unsurprising conclusion drawn by a survey conducted by The Harris Poll on behalf of Stanford Medicine. The poll, which took place between March 2 and March 27 of this year, surveyed 521 PCPs licensed to practice in the U.S. who have been using their current EHR system for at least one month.

The physicians were recruited via snail mail from the American Medical Association Masterfile. Figures for years in practice by gender, region and primary medical specialty were weighted where necessary to bring them into line with their actual proportions in the population of PCPs in the U.S.

According to the survey, about two-thirds of PCPs think EHRs have generally improved care (63%). Two-thirds said they were at least somewhat satisfied with their current systems, though only 18% were very satisfied.

Meanwhile, a total of 34% were somewhat or very dissatisfied with their system, and 40% of PCPs said that EHRs create more challenges than benefits. Also, 49% of office-based PCPs reported that using an EHR detracts from their clinical effectiveness.  Forty-four percent of PCPs said that primary value of EHRs is data storage, while just 8% said that the biggest benefits were clinically-related.

To improve EHRs’ clinical value, it will take a lot of effort, with 51% saying they think EHRs need a complete overhaul.  Seventy-two percent of PCPs said that improving user interfaces could best address their needs in the immediate future.

Meanwhile, 67% of respondents said that solving interoperability problems should be the top priority for EHR development over the next decade, and 43% reported wanting improved predictive analytics capabilities.

Nearly all (99%) of PCPs said that EHR capabilities should include maintaining a high-quality record of patient data over time, followed closely by providing an intuitive user experience. Also, 88% said that providing clinical decision support at the moment of care was important, followed by identifying high-risk patients in their patient panel (86%).

When asked what EHR features they found most satisfying, they cited maintaining a high-quality patient record (73%), offering patients access to medical records (71%), sharing information with providers across the care continuum (65%) and supporting practice/revenue cycle management needs (60%).

However, EHRs still have a long way to go in offering other preferred capabilities, including changing and adapting in response to user feedback, improving patient-provider interaction, coordinating care for patients with complex conditions and engaging patients in prescribed care plans through mobile technologies. Vendors, you have been warned.

Health IT Leaders Fear Insider Security Threats More Than Cyberattacks

Posted on June 8, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A recently-published survey suggests that while most health IT security leaders feel confident they can handle external attacks, they worry about insider threats.

Cybersecurity vendor Imperva spoke with 102 health IT professionals at the recent HIMSS show to find out what their most pressing security concerns were and how prepared they were to address them.

The survey found that 73% of organizations had a senior information security leader such as a CISO in place. Another 14% were hoping to hire one within the next 12 months. Only 14% said they didn’t have a senior infosec pro in place and weren’t looking to hire.

Given how many organizations have or plan to have a security professional in place, it’s not surprising to read that 93% of respondents were either “very concerned” or “concerned” about a cyberattack affecting their organization. The type of cyberattacks that concerned them most included ransomware (32%), insider threats (25%), comprised applications (19%) and DDoS attacks (13%). (Eleven percent of responses fell into the “other” category.)

Despite their concerns, however, the tech pros felt they were prepared for most of these threats, with 52% that they were “very confident” or had “above average” confidence they could handle any attack, along with 32% stating that their defenses were “adequate.”  Just 9% said that their cybersecurity approach needed work, followed by 6% reporting that their defenses needed to be rebuilt.

Thirty-eight percent of the health IT pros said they’d been hit with a cyberattack during the past year, with another 4% reporting having been attacked more than a year ago.

Given the prevalence of cyberthreats, three-quarters of respondents said they had a cybersecurity incident response plan in place, with another 12% saying they planned to develop one during the next 12 months. Only 14% didn’t have a plan nor was creating one on their radar.

When it came to external threats, on the other hand, respondents seemed to be warier and less prepared. They were most worried about careless users (51%), compromised users (25%) and malicious users (24%).

Their concerns seem to be compounded by a sense that insider threats can be hard to detect. Catching insiders was difficult for a number of reasons, including having a large number of employees, contractors and business partners with access to their network (24%), more company assets on the network or in the cloud than previously (24%), lack of staff to analyze permissions data on employee access (25%) and a lack of tools to monitor insider activities (27%).

The respondents said the most time-consuming tasks involved in investigating/responding to insider threats included collecting information from diverse security tools (32%), followed by tuning security tools (26%), forensics or incident analysis (24%) and managing too many security alerts (17%).

HITExpo ThankTanks Spur Online Discussion on the Nature of EHRs, Innovation & Patient Experience

Posted on June 7, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week at the inaugural 2018 Health IT Expo (#HITExpo), we kicked things off with three ThinkTank sessions:

  1. Going Beyond EHRs – https://www.youtube.com/watch?v=ULVQA4xEIRU
  2. Practical Innovation – https://www.youtube.com/watch?v=1Uc9_BCKQ84
  3. Communication & Patient Engagement – https://www.youtube.com/watch?v=60MAP04MoOw

These ThinkTanks were live-streamed via YouTube and were meant to engage members of the #HITMC, #HITsm, #hcldr and other online communities who could not be with us in person in New Orleans. Looking back over the tweets I believe it would be safe to say: mission accomplished.

The online discussion around the ThinkTanks was very rich and involved many different perspectives. During ThinkTank 1 Jim Tate had a keen bit of insight to share based on a comment made by panelist Shahid Shah of Netspective Media:

This was quickly followed by another interesting statement from Shah:

An interesting suggestion in ThinkThank 1 came from Dr. Fatima Paruk, Chief Medical Officer, Population Health at Allscripts – that it was never too late to get physicians involved in EHR optimization given that they are one of the main users of EHR systems. This was especially relevant given how much EHR frustration contributes to physician burnout.

Jeremy Coleman, one of the HITExpo’s social media ambassadors did an expert job at distilling a 5min during ThinkTank 1 into a single tweet:

The most interesting comment in ThinkTank 1 was made by Justin Campbell of Galen Healthcare. He suggested that one way to go beyond the EHR was to use the audit log information to identify workflow bottlenecks, training opportunities and UI improvements.

The second ThinkTank generated a spirited discussion amongst the panelists and with the online audience when the topic of blockchain technology was brought up. It started when John Lynn made the following statement:

Jared Jeffery from KLAS Research then immediately followed up his tweet with this humorous counter-point:

I agree with both John and Jared. The last thing we need is over-inflated hype around blockchain in healthcare. The technology itself holds promise but as an enabler of other technologies and processes. Simply slapping blockchain on existing processes is not going to yield the innovation healthcare needs. We need something more. The good news is that some pioneering organizations and HealthIT companies are experimenting with blockchain which will hopefully lead to incremental improvements.

Experimentation and the willingness to do something was on the mind of Jerry Cade – one of the panelist in ThinkTank 2. He had a poignant warning for all of us in healthcare:

In my opinion the most practical piece of advice of the day was shared by Shahid Shah during ThinkTank 2. It’s certainly something I’m going to pay more attention to in the future:

Your truly had the opportunity to moderate ThinkTank 3 and it was a blast. We had an amazing set of panelists that included nurses, HealthIT insiders, industry experts and the voice of the patient. It resulted in a robust discussion on the nature of patient experience.

Grace Jaime of Oneview Healthcare shared a keen insight which triggered a round of discussion on the need to clearly measure patient experience and communication effectiveness – If you can’t measure something, you can’t improve:

Grace Cordovano, professional patient advocate, then had this to add:

During ThinkTank 3 Sarah Bennight of Stericycle Communication Solutions made an interesting observation about patient advocacy and how it could be modeled after a legal precedent:

If you didn’t have the chance to catch the ThinkTanks live, I’d encourage you to watch the recordings (links above). The sessions were filled with valuable insights and practical advice that you can use right away. It was a lot of fun to participate in these ThinkTanks and I am definitely looking forward to doing more in the future.

In closing I think this tweet summed up the overall sentiment (from friend Ashley Dauwer at MEDITECH):

IBM Watson Health Layoffs Suggests AI Strategy Isn’t Working

Posted on June 6, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

IBM Watson Health is apparently making massive cuts to its staff, in a move suggesting that its healthcare AI isn’t working.

Watson Health leaders have argued that AI (which Watson Health leaders call “cognitive computing”) as the solution to many of the healthcare industry’s problems. IBM pitched Watson technology as a revolutionary tool which could get to the root of difficult medical problems.

Over time, however, it’s begun to look like this wasn’t going to happen, at least for the present. Among other high-profile goofs, IBM Watson has struggled with applying the supercomputing tech to oncology, which was one of its main goals.

Now IBM Watson Health has slashed up to 70% of its staff, according to sources speaking to The Register. The site reports that most of the layoffs are cutting staff within companies IBM has brought in an effort to build out its healthcare credentials. These include medical data company Truven, acquired in 2016 for $2.6 billion, medical imaging firm Merge, bought in 2015 for $1 billion and healthcare management firm Phytel, the site reports.

The cuts reflect a major strategic shift for Watson Health, which was one of IBM’s flagship divisions until recently. Having invested heavily in businesses that might have helped it dominate the health IT world, it now appears to be rethinking it’s all in approach.

That being said, no one has suggested that IBM Watson Health will disappear in a poof of smoke. IBM corporate leaders seem dedicated to an AI future. However, if this report is correct, Watson Health is being reorganized completely. Not too much of a surprise since given how hyped it was, it would have been almost impossible for it to live up to the hype.

To me, this suggests that rolling out healthcare AI tools might call for a completely different business model. Rather than applying brute force supercomputing tools to enterprise healthcare issues, it may be better to build from the ground up.

For example, consider Google’s approach to healthcare AI supercomputing. UK-based DeepMind is building relationships and products from the ground up. Working with the National Health Service DeepMind Health is bringing mobile tools and AI research to hospitals. Its mobile health tools include Streams, a secure mobile phone app which feeds critical medical information to doctors and hospitals.

In my opinion, the future of AI in healthcare will look more like the DeepMind model and less like IBM Watson’s top-down approach. Building out AI-based tools and platforms for physicians and nurses first just makes sense.

“Shadow” Devices Expose Networks To New Threats

Posted on June 4, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new report by security vendor Infoblox suggests that threats posed by “shadow” personal devices connected to healthcare networks are getting worse.

The study, which looks at healthcare organizations in the US, UK, Germany, and UAE, notes that the average organization has thousands of personal devices connected to their enterprise network. Including personal laptops, Kindles and mobile phones.

Employees from the US and the UK report using personal devices connected to their enterprise network for multiple activities, including social media use (39%), downloading apps (24%), games (13%) and films (7%), the report says.

It would be bad enough if these pastimes only consumed network resources and time, but the problem goes far beyond that. Use of these shadow devices can open up healthcare networks to nasty attacks. For example, social media is increasingly a vector of malware infection, where bad actors launch attacks successfully urging them to download unfamiliar files.

Health IT directors responding to the study also said there were a significant number of non-business IoT devices connected to their network including fitness trackers (49%), digital assistants like Amazon Alexa (47%), smart TVs (46%), smart kitchen devices such as connected kettles of microwaves (33%) and game consoles such as the Xbox or PlayStation (30%).

In many cases, exploits can take total control of these devices, with serious potential consequences. For example, one can turn a Samsung Smart TV into a live microphone and other smart TVs could be used to steal data and install unwanted apps.

Of course. IT directors aren’t standing around and ignoring these threats and have developed policies for dealing with them. But the report argues that their security policies for connected devices aren’t as effective as they think. For example, while 88% of the IT leaders surveyed said their security policy was either effective or very effective, employees didn’t even know it was in effect in many cases.

In addition, 85% of healthcare organizations have also increased their cybersecurity spending over the past year, and 12% of organizations have increased it by over 50%. Most HIT leaders appear to be focused on traditional solutions, including antivirus software (60%) and cybersecurity investments (57%). In addition, more than half of US healthcare IT professionals said their company invests in encryption software.

Also, about one-third of healthcare IT professionals said the company is investing in employee education (35%), email security solutions and threat intelligence (30%). One in five were investing in biometric solutions.

Ultimately, what this report makes clear is that health IT organizations need to reduce the number of unauthorized personal devices connected to their network. Nearly any other strategy just puts a band-aid on a gaping wound.

Alexa Voice Assistant Centerpiece Of Amazon Health Effort

Posted on June 1, 2018 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

I don’t know about you, but until recently I had thought of the Amazon Echo is something of a toy. From what I saw, it seemed too cute, too gimmicky and definitely too expensive for my taste. Then I had a chance to try out the Echo my mother kept in her kitchen.

It’s almost embarrassing to say how quickly I was hooked. I didn’t even use many of Alexa’s capabilities. All I had to do was command her to play some music, answer some questions and do a search on the Amazon.com site and I was convinced I needed to have one. Its $99 price suddenly seemed like a bargain.

Of course, being a health IT geek I immediately wondered how the Alexa voice assistant might play a part in applications like telemedicine, but I was spending too much time playing “Name That Song” (I’m an 80s champ) to think things through.

But I had the right instincts. It’s become increasingly clear that Amazon sees Alexa as a key channel for reaching healthcare decision-makers.

According to a story appearing on the CNBC website, Amazon has built a 12-person team within the Alexa voice-assisted division called “health & wellness” whose focus is to make Alexa more useful to healthcare patients and providers. Its first targets include diabetes management, care for mothers and infants and aging, according to people who spoke anonymously with CNBC.

Of course, this effort would involve working through HIPAA rules, but it’s hard to imagine that a company like Amazon couldn’t buy and/or cultivate that expertise.

In the piece, writers Eugene Kim and Christina Farr argue that the mere existence of the health & wellness group is a clear sign that Amazon plans to bring Alexa to healthcare. As long as the Echo can share and upload data in a secure, HIPAA-compliant fashion, the possibilities are almost endless. In addition to sharing data with patients and clinicians, this would make it possible to integrate the data with secure third-party apps.

Of course, a 12-person unit is microscopic in size within a company like Amazon, and from that standpoint, the group might seem like a one-off experiment. On the other hand, its work seems more important when you consider the steps Amazon has already taken in the healthcare space.

The most conspicuous move Amazon has made in healthcare came in early 2018, when it announced a joint initiative with Berkshire Hathaway and J.P. Morgan focused on improving healthcare services. To date, the partnership hasn’t said much about its plans, but it’s hard to argue that something huge could emerge from bringing together players of this size.

In another, less conspicuous move, Alexa took a step towards competing in the diabetes care market. In the summer of 2017, working with Merck, Amazon offered a prize to developers building Alexa “skills” which could help people with diabetes manage all aspects of their care. One might argue that this kind of project could be more important than something big and splashy.

It’s worth noting at this point that even a monster like Google still hasn’t made bold moves in healthcare (though it does have extraordinarily ambitious plans). Amazon may not find it easy to compete. Still, it will certainly do some interesting things, and I’m eager to see them play out. In fact, I’m on the edge of my seat – aren’t you?