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Rattled by Cyberattacks, Hospitals Push Device Makers to Improve Security

Exposed

More than 150 million personal health records have been breached in health-care company hacks since 2009.

In stepping up their efforts, hospitals have gone beyond building firewalls and taking other actions to shield their own networks—they have moved into demanding information like the software running devices that manufacturers have long considered proprietary. The requests have generated tensions between the sides.

Medical-device manufacturers including Royal Philips NV and Boston Scientific Corp. have begun adding new features and disclosing more about products—such as which third-party software they contain—to help hospitals protect devices against attacks, health-care and security experts said.

The interconnectivity has given rise to new headaches for hospital executives, worried about the consequences of a hack. Their fears were brought home two years ago, when the WannaCry and NotPetya cyberattacks disrupted operations at some hospitals, forcing the cancellation of some surgeries.

Hospital-technology officials say gaining access to the software running inside devices—and knowledge of its vulnerabilities—would help them build firewalls and other defenses against attacks. The Food and Drug Administration recommended in guidance proposed last October that manufacturers provide software disclosures to hospitals. Partners HealthCare, based in Boston, this year required for the first time that an unnamed device maker reveal its device software as part of their contract, said Julian Goldman, Partners’ medical director of biomedical engineering.

NewYork-Presbyterian, meanwhile, is seeking contracts with device makers that allow independent tests of device cybersecurity, called “penetration tests,” said Jennings Aske, the hospital network’s chief information security officer.

Last year, NewYork-Presbyterian began working with outside consultants to assess the cyberdefenses of the corporate networks of suppliers, including medical-device makers, Mr. Aske said. In 2017, the hospital dropped plans to buy infusion pumps manufactured by Smiths Group PLC after the Department of Homeland Security warned that hackers could take control of the pumps, 

Smiths said it released a fix in 2017. “While we were disappointed with the NYP decision to purchase another system, we are confident in the firmware update and that the pump is safe for patients,” the spokesman said.

Vizient Inc., which negotiates contracts for products and services on behalf of 3,100 health systems in the U.S., added cybersecurity questions for the first time to requests now under consideration for bids across 10 medical-device categories, said Ross Carevic, Vizient’s director of technology sourcing. The questions included whether device data are encrypted and what password procedures are used. Vizient plans to factor the answers into contract-award decisions. 

Philips, a major supplier of imaging, respiratory and other gear to hospitals, often receives such cybersecurity questionnaires, said Michael McNeil, the company’s global product security officer. He said it would be helpful if the requests were standardized in order to make answering them more routine.

Boston Scientific, which supplies products like lasers and catheters used by hospitals in surgeries and heart procedures, said it is facing requests for more stringent password features like automatic time-outs, said Ken Hoyme, director of product security. But password timeouts could interfere during time-sensitive surgical procedures, he said.

The health-care companies, including hospitals, reported 148 hacks exposing personal-health information last year, up from five hacks in 2009. The Department of Homeland Security last year issued 30 advisories about cybersecurity vulnerabilities in medical devices, up from 16 the year before, according to MedCrypt, which makes security software for medical devices.

Device makers say hospitals’ cybersecurity demands can be complicated and bog down sales negotiations. “These contracts are taking more time to negotiate,” said James Kinkela, corporate counsel at Boston Scientific. “The contracting has definitely gotten more complex.”

The attention to cybersecurity follows health-care’s embrace in recent years of digital technologies, from electronic medical records to mobile lab tests. For hospitals, internet-connected devices offer the potential to monitor patients more continuously and closely, and use the data to guide—and improve—care.

“There are struggles right now about who owns which piece of cybersecurity,” said Stephanie Domas, vice president of research and development at cybersecurity consultant MedSec. Hospitals don’t know enough about the security of devices on their networks, and manufacturers don’t always provide software updates to fix vulnerabilities quickly, she said.

Hospitals are pushing medical-device makers to improve cyber defenses of their internet-connected infusion pumps, biopsy imaging tables and other health-care products as reports of attacks rise.

Rattled by recent global cyberattacks, U.S. hospitals are conducting tests to detect weaknesses in specific devices, and asking manufacturers to reveal the proprietary software running the products in order to identify vulnerabilities. In some cases, hospitals have canceled orders and rejected bids for devices that lacked safety features.

Hospitals, after a decade of racing to wire up their medical records and an explosion of internet-connected medical devices, are growing more aggressive with technology suppliers amid pressure to better defend against incursions that could threaten patients and cause costly disruptions. Credit-rating agency Moody’s Investors Service in February ranked hospitals as one of the sectors most vulnerable to cyberattacks.

4 Things Seniors Should Know About Treating Depression

Author: Teresa Greenhill

When we feel physical pain, we reach for ibuprofen or call our doctors for advice. So, why shouldn’t seniors do the same when they are experiencing the physical and mental pain of depression? You don’t need to suffer due to stigma, and you don’t need to take on this battle alone. Here’s what you need to know about getting help for your depression. 

Medicare Can Help with Mental Health Too 

Most seniors know they can rely on Medicare for their annual check-ups and physical health needs. For seniors struggling with depression and other mental health issues, however, Medicare can offer coveragethat can help as well. For example, Medicare Part B offers some coverage for outpatient services, but it may not be enough. So, stay informed about your Medicare plan options and any changes that could impact your ability to seek care for your depression. You may want to research supplemental Medicare plansthat could offer even more benefits for your mental health so you can get the help that you need to feel like yourself again. These plans can also help out with prescription drug costs, which can come in handy if you need medication to alleviate your depression symptoms. 

Asking for Help Is Often the Hardest Step 

Depression is common among adults in America, and yet there is still so much stigmaaround getting treatment. As a society, we have a long history of treating mental illness differently than other health conditions, but that really shouldn’t be the case. The truth is, millions of Americansare dealing with mental health issues every single day, but less than half of those people seek out the help they need. You can reduce the voice of stigma in yourself by knowing that you are not alone and that you are not weak for wanting to get better. Start by searching for a therapistwho can help you get on the road to recovery and develop ways to cope along the way. You can also check to see if your therapist will accept Medicare or if you will need to find another way to pay for your treatment or another therapist that fits your Medicare coverage. 

Social Connection Can Ease Symptoms of Depression 

There are so many things you can do to find relief from depression. You may need to make a self-care checklistto remind yourself to practice basic healthy habits, like taking a shower and eating healthfully. Those efforts can help you stay afloat when you are feeling down, but one of the most impactful ways seniors can ease feelings of depression is to stay socially connected. When you feel isolated, research shows you are more likely to feel depressed, which can cause you to isolate yourself even more. You can prevent isolation and depression by reaching out to loved ones for support or by taking up a new hobby that allows you to meet new people, such as volunteering at a local charity or taking a yoga class. Plus, staying physically active can ease feelings of depression as well, so you will be reaping more benefits for your mental health. 

Addiction Often Occurs With Depression in Older Adults 

Getting help for your depression is a good first step towards taking back control of your life. It’s also important to note that depression and addictionoften occur together. Which comes first is hard to pinpoint, but what matters is that those suffering from addiction address mental health issues during their treatment. Going through treatment can make depressive symptoms worse, so it’s also important to take this into account as well. For seniors, alcohol abuseis very common when there is an untreated mental health issue, such as depression. Since drinking can make depression worse, it’s crucial to recognize whether you have an unhealthy relationship with alcohol or other substances and seek out comprehensive treatment to help. 

If you’re a senior who is struggling with depression, you shouldn’t have to suffer alone. There are professionals who can help you feel like yourself again and help you see your way out of the darkness. You just have to reach out and get that help for yourself. 

Author: Teresa Greenhill

Five Reasons Why Patient Data Privacy and Control is so Important by Dr. Moira Schieke

The ancient Greek father of medicine, Hippocrates, knew that trust was a fundamental tenet for the effective practice of medicine.  How can a patient seek the care of a stranger without the establishment of a fiduciary trust?  A patient must reveal the most personal, private information about themselves and therefore must possess the utmost confidence in their physician to keep their information in confidence and all uses of their data transparent.  Yet, in today’s digital social media age, does privacy really exist?  Large companies make unfathomable fortunes harvesting all manner of data from financial information to the mundane minutia of daily life.  In this environment, here are five reasons why patient data privacy and control are more important than ever:

1.  Maintain the fundamental fiduciary doctor-patient relationship.

            “Things that are holy are revealed only to men who are holy.”  – Hippocrates, Greek physician (460 BC – 377 BC)

It is critical for the health care system to maintain the trust between doctor and patient in a patient-centric dynamic.  If patients believe that information they give their doctors and healthcare professionals, and by extension, these larger institutions is going to be used against them and not in the patient’s best interest, then patients will be reticent to provide needed details for their own health and well-being thus deteriorating their own healthcare.  If patients believe in the ultimately altruistic interests of their doctors, they will be more likely to provide critical details and take an active role in their care.  In addition, there is great financial pressure to utilize algorithms to automate care decisions to reduce costs, thereby increasing institutional and industry profits.  The doctor-patient relationship prevents direct access of industry-designed algorithms that could work more in the interest of industry profits, rather than to improve patient health.

2.  Higher data quality.

            “Conclusions which are merely verbal cannot bear fruit, only those do which are based on demonstrated fact.”  – Hippocrates, Greek physician (460 BC – 377 BC)

The equation is simple: higher quality data means higher quality medical care.  One of the advantages of the digital age is the ability to synthesize huge amounts of data quickly.  However, the data used must be accurate.  Electronic health records are known to contain many errors, and patients can assure accuracy of their personal health data when they have access to check it.  With patient trust through data use transparency and data control comes more detailed and better data in, better and more accurate and precise conclusions out. 

3.  Bringing back fairness and balance to current industry-centric data monopolies.

“...while calling on the gods, a man should himself lend a hand.”  – Hippocrates, Greek physician (460 BC – 377 BC)

It is currently a data “gold rush” given current U.S. data and privacy regulations, and many large companies have made fortunes by making their customers into their commodity.  They sell consumer data non-transparently to unidentified entities that use the data for uncertain purposes with ambiguous ethics, creating a data economy with network effects favoring a few platforms able to collect and lock up the largest masses of personal data.  The data being recorded about a patient forms a remarkably detailed picture of their life. This picture is incredibly valuable when unified and stored both as a singularity and in conjunction with thousands, even millions of other lives.  These pictures reveal patterns that permits the personalization of medicine, insurance, finances and more but the question is, who owns and controls this valuable picture?  And what about the risks associated with massive data leaks through hacking and other data breaches?  Transparency and personal data controls are keys to creating a balanced and fair patient-centric digital data economy that promotes diverse and open competition.

4.  Assure patient access to their data.

A wise man ought to realize that health is his most valuable possession.”  – Hippocrates, Greek physician (460 BC – 377 BC)

Patient control of access to their own data is needed for a number of reasons.  First, it promotes data exchange across healthcare systems to assure access to critical health data wherever the patient may seek care.  Healthcare systems should be required to provide patients with their full medical record in electronic in a timely manner, and those systems who do not comply should be held accountable for data-blocking.  If we assure patients control their data, it will allow them to choose healthcare systems or associated third parties, thereby redistributing data across the economy to allow smaller companies, who may be more ethical and have better solutions, to compete.  In addition, patients could allow researchers access to their personal data.  Many researchers currently have trouble gaining access to data now in data silos created by industry purchases and other private sector agreements.  Researchers do not have access to big data needed to discover tomorrow’s cures and medical advancements.   Last, patients who are more engaged in their own healthcare tend to have better health outcomes overall, and patient data access allows patients to become more engaged in their own health.

5.  Preserve basic human rights.

“Wherever the art of medicine is loved, there is also a love of humanity.”  – Hippocrates, Greek physician (460 BC – 377 BC)

The “Right to Privacy” is a fundamental human right as declared by the UN Universal Declaration of Human Rights drafted after WWII that has been adopted around the world.  When this Declaration was adopted in 1948, the world had not yet imagined our new digital age.   Recently, however, some prominent leaders who remember the excesses of totalitarian regimes, have started to work to sharpen public opinion and remind us that our privacy is indeed a basic human right.  The right to privacy and control of data about our bodies is essential to preserving the dignity and respect of each individual, as well as trust in the medical community.  In the digital age, it will become the fiduciary duty of each doctor to protect the digital data privacy rights for each patient as a basic human right.

We are entering a new technological era for healthcare where we must commit to new standards of patient data privacy, data use transparency, and personal data control.  We have outlined five key reasons why this general topic is now more important than ever.  It will take many years of work on the part of academics, healthcare systems, industry, and government to fully assimilate all associated ethical, societal, technological, and business considerations to assure that we manage patient data in the right way.

Dr. Moira Schieke Bio
Founder and CEO of Cubismi, Dr. Moira Schieke is a cancer imaging clinical and research Radiologist based in Madison, WI.  Dr. Schieke completed her fellowship in cancer imaging at Dana Farber Cancer Institute in Boston, research fellowships at the National Institutes of Health in Bethesda, MD, and is adjunct Assistant Professor at the University of Wisconsin at Madison.  Dr. Schieke is a nationally recognized artist and painter. Cubismi was born of a critical need for cancer imaging innovation for earlier detection and better management of cancer.

Sanford Health and Good Samaritan close merger

Sanford Health and the Evangelical Lutheran Good Samaritan Society completed their merger, the organizations announced Wednesday.

Sanford, which has 45 hospitals, more than 1,300 physicians and 28,000 employees, adds Good Samaritan and its 200-plus post-acute, skilled-nursing, hospice, assisted-living, rehabilitation and home-health facilities to its network, along with Good Samaritan’s 19,000 employees. Their combined footprint spans 26 states.

The combination of the Sioux Falls, S.D.-based not-for-profits earned the necessary government approvals in August. Merger talks began in late 2017, when they started mapping out the integration process and growth opportunities, executives said.

David Horazdovsky remains CEO of Good Samaritan and has joined Sanford’s corporate leadership team. Randy Bury has transitioned to president of Good Samaritan from his previous role as Sanford’s chief administration officer.

“Wherever you combine acute-care operations with post-acute care you are going to find opportunities,” Kelby Krabbenhoft, president and CEO of Sanford Health, told Modern Healthcare.

Good Samaritan adds home and community-based services that can fill any gaps in care, Horazdovsky said.

“We see great growth opportunities,” he said.

The merger’s close is the latest transaction in an active post-acute sector as organizations and investors look to capitalize on the huge number of aging baby boomers. Coordinating care after patients leave the hospital is a key strategy for health systems that want to avoid health complications that can bring readmission penalties.

“The organization that can provide care in the most coordinated way will be the most successful—that is what we are shooting for,” Bury said.

Not-for-profit health system ProMedica expanded beyond its core business in its acquisition of struggling nursing home provider HCR ManorCare. Humana and private equity firms bought Kindred Healthcare and Curo Health to create the country’s largest hospice operator. LHC Group and Almost Family also combinedto form the second-largest home health provider in the country.

Consolidation is not expected to wane, experts said.

Sanford will continue to talk with other health systems about additional merger, acquisition or joint-venture opportunities as it looks to build out its long-term care operations, Krabbenhoft said. That marks a departure from the organization’s traditional focus on acute-care partnerships and acquisitions, he said.

“This moment today is an inflection point for the company as we are required as a function of our responsibility to now think about our facilities and operations like we never have before,” Krabbenhoft said.

From Modern Healthcare

Partners, Harvard Pilgrim table merger talks

Partners HealthCare and Harvard Pilgrim Health Care are tabling their planned merger after executives reportedly felt the deal was getting too complicated.

Boston-based Partners, Massachusetts’ dominant health system, and Wellesley, Mass.-based Harvard Pilgrim, the state’s second-largest health plan, announced in May they were considering a possible merger. On Friday, the not-for-profit companies confirmed the merger talks were on hold.

“Our discussions with Partners HealthCare have always been focused on exploring ways we can improve and enhance the patient experience while helping to control costs,” Harvard Pilgrim CEO Michael Carson said in a statement. “We continue to evaluate opportunities to collaborate with Partners on this important mission.”

Partners CEO Dr. David Torchiana told the Boston Globe the deal was getting too complicated and was bound to face regulatory scrutiny. He said the announcement doesn’t rule out the possibility of a future deal.

“I don’t think either organization is sure that it’s something that’s actually possible to achieve … in this environment right now where there’s such intense scrutiny of every move,” Torchiana told the newspaper.

Partners’ existing health plan, Neighborhood Health Plan, reported an operating loss of $5 million in the third quarter of 2018, compared with an operating gain of $34 million in the prior year period. NHP’s premium revenue dropped 64% during the quarter. Partners is rebranding the health plan, and beginning Jan. 1, will call it AllWays Health Partners.

Partners, whose hospitals include Brigham and Women’s Hospital and Massachusetts General Hospital, is still awaiting regulatory approval to acquire Care New England Health System of Providence, R.I.

Beth Israel Deaconess Medical Center and Lahey Health are still awaiting regulatory approval to form a health system they say will be large enough to compete with Partners. The combined entity would have 10 acute-care hospitals, compared with Partners’ eight, and would have three affiliate hospitals and more than 4,000 physicians.

The Massachusetts Health Policy Commission issued a highly critical report on that proposed deal in July. The report said the Beth Israel Deaconess-Lahey deal’s cost outweighed its benefits, and nothing would prevent the combined entity from raising prices, other than the state’s annual 3.1% cost growth limit.

In June, Harvard Pilgrim’s long-time CEO, Eric Schultz, abruptly resigned due to unspecified behavior he said violated the company’s code of conduct. A Harvard Pilgrim spokeswoman said the resignation didn’t affect its discussions with Partners.

John Hopkins Nurses Speak Out!

Nurses, Community Leaders to Discuss New Reports Documenting Johns Hopkins Hospital’s Failure to Provide Adequate Charity Care and Address Problems in Patient Care.

Johns Hopkins nurses will present three new reports documenting patient care concerns at the hospital and how these concerns extend far into the city of Baltimore at a town hall planned for Saturday, Dec. 1, 2018. The town hall, titled “Hopkins Nurses Speak Out!” will be held at the Reginald F. Lewis Museum of Maryland African-American History & Culture in Baltimore.

Also participating in the town hall will be Baltimore Councilmembers, Shannon Sneed, Kristerfer Burnett, Zeke Cohen, and Robert Stokes, Sr. as well as, Maryland Delegate Brooke Lierman. Reverend Marlon Tilghman, co-chair of Bridge Maryland, and Pastor of Ames United Methodist Church, Betty Robinson, community organizer and former Senior Research Coordinator at Johns Hopkins School of Public Health and Marisela Gomez, M.D., Ph.D., author and community organizer, will participate as community respondents to the report findings.

The new reports cover three main areas: A unit-by-unit survey of patient care conditions in the hospital, an analysis of Johns Hopkins tax exemptions and public rate support and the community benefits and charity care it provides in exchange, and an assessment of how the institution is responding to the ongoing problem of workplace violence.

What:  Town Hall featuring presentation of new reports on Johns Hopkins Hospital patient care and public accountability.

When: Saturday, Dec. 1, 10:30 a.m. – 12:30. p.m.

Where: Reginald F. Lewis Museum of Maryland African-American History & Culture, 830 E Pratt St., Baltimore. (Discounted parking available in garage at 815 E. Pratt Street.)

The reports, which will be available at the town hall and on request, include:

Foundations of Care:  Upholding the Legacy of Hopkins’ Nurse Pioneers

Johns Hopkins Hospital Patient Care Report – This report’s findings are based on a recent unit-by-unit survey conducted by nurses that work at Johns Hopkins Hospital. It flags chronic hospital-wide problems such as short and inappropriate staffing, high turnover, a lack of critical supplies, and shoddy equipment.

Breaking the Promise of Patient Care: How Johns Hopkins Hospital Management Shortchanges Baltimore and Puts Patients and the Community at Risk – This report, produced by researchers from National Nurses United and the AFL-CIO, documents that the hospital receives far more in annual tax exemptions and public rate support than it provides in charity care and community benefits, despite the tremendous need for both in the communities surrounding the hospital.

Nurses at Risk: Insufficient Protections at Johns Hopkins Hospital Compromise Nurse and Patient Health and Safety – This report reveals the institution’s failure to adopt robust policies to prevent and respond to workplace violence and how this undermines and endangers patients and nurses.

“We are very excited to share and discuss the report findings with our community,” said Kimberly Henriquez, RN, Oncology. “They reveal a wide discrepancy between the image the institution projects, and what’s really going on day-to-day, unit-by-unit. Nurses are organizing to close that gap so that our patients and our community get the care they deserve.

“We are inviting nurses and the wider community to come to the town hall so that together we can hold Johns Hopkins Hospital accountable to its founder’s vision and to the community he meant it to serve,” said Annie Embertson, RN. Endoscopy. “We are inspired by the legacy of Hopkins’ own nurse pioneers who showed us that to be effective patient advocates we absolutely must speak out.”

Megan Callahan Will Head up Lyft’s Health Care Efforts

After a months-long search, Lyft has hired a leader for its growing health care business, which helps patients get rides to non-emergency medical appointments. The company is set to announce it’s hired Megan Callahan, formerly the chief strategy officer for Change Healthcare, a company that merged with McKesson in 2017, as its health lead.

The hire comes as Lyft is looking to ramp up revenues ahead of a possible IPO 2019. The company’s chief business officer David Baga told CNBC by phone that health represents a “sizable chunk” of Lyft Business, which is set to achieve a annualized revenue run rate of $1 billion by the end of the year. Lyft told CNBC that the number of health care rides tripled from the third quarter of 2017 to the same period a year later.

Lyft’s primary competitor, Uber, also views health as a growth opportunity. Both companies have built out dedicated teams in health, and have formulated a strategy to work with stakeholders in the industry to help patients who need help to get to the doctor’s office on time.

Non-emergency medical transportation is attractive for both ride-sharing companies because insurers, including some Medicaid and Medicare plans, will often cover the cost of the ride for patients. There’s a huge incentive for health plans to make transportation easier, as studies have found that a lack of transportation is a key reason why patients avoid the doctor’s office.

Lyft’s focus is to forge partnerships in health care with traditional players, including health systems, medical transportation brokers and health IT companies. For instance, in March it signed an exclusive deal with medical record technology provider Allscripts to make it easier for doctors to book Lyft rides for their patients.

To that end, Baga, the chief business officer, told CNBC it needed to hire an operator from the industry to maintain and build on these relationships.

“We wanted someone for the job who lives and breathes health care,” he explained. “But we also wanted someone who could understand the key challenges, and be willing to break from the status quo.”

Callahan told CNBC she joined Lyft because of the opportunity to improve access to health care services, particularly for low-income or elderly users.

She also said that Lyft’s deep knowledge about health stood out relative to other technology players.

“I was gobsmacked by the level of understanding on HIPAA and PHI,” she said, referring to the complex web of federal privacy rules and regulations that govern how health data is stored and shared. “They (Lyft) had clearly taken the time to understand the industry.”

Lyft is also moving into other areas, including working with pharmaceutical companies to people get to clinical trial sites and arranging rides for physical therapists to treat patients in their homes.

Experts say that’s the tip of the iceberg for Lyft and other new transportation entrants.

“There’s home care, there’s delivery of goods and supplies — it becomes a market in the tens of billions of dollars if you’re looking at logistics opportunities in health care,” said John Brownstein, co-founder of a company in the space called Circulation Health that partners with Lyft. Circulation was recently acquired by one of the largest brokers in the space, Logisticare.

Callahan didn’t rule out any of these sorts of opportunities, but said her near-term goal was to look for more ways to increase rides and reduce missed appointments.

Athenahealth sold to Veritas Capital for $5.7 billion

Athenahealth has agreed to be acquired by a Veritas Capital and Evergreen Coast Capital affiliate for $5.7 billion, the companies announced Monday morning.

Athenahealth will continue to be its own brand, but Veritas and Evergreen will merge it with Virence Health, the analytics and software firm formerly known as the Value-Based Care Solutions Group, which GE Healthcare acquired earlier in 2018.

Virence Chairman and CEO Bob Segert will lead the newly combined company.

“Combining with Virence will create new opportunities for collaboration and growth,” Athenahealth Executive Chairman Jeff Immelt said in a statement.

Athenahealth has been facing takeover attempts since at least 2017, when Elliott Management first tried to buy the company. Elliott Management supports the Veritas-Evergreen acquisition. The transaction “represents an outstanding, value-maximizing outcome for Athenahealth shareholders,” Elliott partner Jesse Cohn said in a statement.

Athenahealth will hold an earnings call later Monday. In a third-quarter earnings report released Friday, the company reported it booked less business compared to the same period of 2017. Revenue for the quarter was $329.5 million, according to the company’s new accounting standards, and $331.4 million according to the old standards, up 9% over the year-before quarter.

Athenahealth’s stock was up nearly 10%, to $131.97 a share at the end of trading Monday.