News 12/8/23

Top News

Providence will sell its Acclara revenue cycle management company to R1 RCM for $675 million in cash, warrants to purchase $135 million worth of R1 shares, and a 10-year contract to receive revenue cycle management services from R1.

R1 shares, which are up 11% in the past 12 months versus the S&P 500’s 16% rise, rose slightly on the news, valuing the company at $4.7 billion.

Reader Comments

From Green Slime: “Re: award. See this LinkedIn post about another vanity award.” Dayton Children’s CIO J.D. Whitlock is tongue-in-cheek proud to be nominated for “Most Pioneering Magnetic Leader Revamping The Healthcare, 2024,” which he can win by paying $2,800. I found a back issue from issuer The CIO World, which is full of grammatical errors and odd wording that makes it obvious that its editorial terroir is not nearby. It describes itself as “an archway that caters to Entrepreneurs’ quench of technology and business updates.” Still, what they are doing is legal and in fact is perhaps the perfect business – selling vanity strokes to folks who crave them, even those who work in The Healthcare. The downside is that you look like a loser when you’re caught bragging on an obvious pay-for-play award.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor SnapCare.SnapCare is an AI-enabled workforce marketplace that serves the entire continuum of care. Its platform offers healthcare facilities complete visibility into the ideal talent mix for their unique needs and associated costs. The company designed its workforce solutions to significantly improve client savings and efficiencies, minimizing the need for intermediate agencies, returning control to healthcare facilities, and ensuring total transparency in pay and pricing. Its pioneering technology and comprehensive staffing services offer a smarter way for facilities to manage their workforce needs and deliver quality patient care. Thanks to SnapCare for supporting HIStalk.

I found this SnapCare explainer video on YouTube.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Novant Health will outsource some of its IT department’s work to India-based Wipro, but declines to say how many positions will be affected.

People

Industry long-timer Brent Dover (Kalderos) joins AI-powered clinical data management technology vendor Carta Healthcare as CEO.

William O’Toole, JD (O’Toole Law Group) joins DrFirst as counsel.

Fortified Health Security hires Greg Breetz, Jr. (Valera Health) as CFO.

Sarah Jones, MBA (Firefly Health) joins B.well Connected Health as chief outcomes officer.

Announcements and Implementations

InterSystems announces GA of TrakCare Assistant, a search-based navigation tool for its TrakCare EHR. Internal testing shows that Assistant reduces EHR interaction time by up to 66%.

In Canada, Fraser Health will pilot the use of Google Cloud’s generative AI to help create clinical documentation in Meditech Expanse.

Three-fourths of ambulatory care physician leaders who were surveyed by WellSky say that their organizations don’t have relationships with post-acute care providers, and most referrals to them are sent by fax or telephone. Most respondents expect their participation in value-based care programs to increase, while more than half of those surveyed say they don’t participate in Medicare’s Transitional Care Management because of shortages of staff, data, or technology.

A new KLAS report on data and analytics services lists Chartis, CitiusTech, Impact Advisors, and Prominence as being broadly validated across four disciplines – advisory consulting, technology services, operations improvement consulting, and managed services.

Privacy and Security

HHS lays out its plan to improve cybersecurity in healthcare, which includes setting healthcare organization performance goals, providing financial incentives for implementing cybersecurity practices, and enforcing cybersecurity standards within Medicare, Medicaid, and HIPAA.

Epic raises concerns about an ONC proposal that would require EHR vendors and HIEs to remove reproductive health information from data-sharing programs upon patient request. Epic says that the proposal would increase clinician documentation burden and is not technologically feasible, while a family doctor observes, “EHRs have been working so hard to share data automatically that we’re now behind in thinking about how to not share when that data can be used to criminalize a patient.” Proponents say that patients and providers could be charged with felonies in states where abortion is illegal if information from abortion-legal states is shared across state lines.

Washington University (MO) sues the state’s attorney general over his demand for access to patient records from its transgender center, which he is seeking under a consumer protection law that addresses false advertising. The AG’s office says it is entitled to information about treatment, referrals, prescriptions, and compliance with standards of care, while the university says that HIPAA pre-empts state law and allows disclosure of PHI only to a “health oversight agency.”

Security researchers report that a security flaw in the DICOM medical imaging standard has caused millions of patient images and exam notes to be exposed to the Internet. The affected servers, most of them hosted in the cloud either did not have security measures enabled or used weak authorization.

Other

Ardent Health Services restores access to Epic after nearly two weeks of downtime following a November 23 cyberattack.

The local paper profiles Jonathan Hatfield, who graduated college with a degree in bible studies, became a night shift janitor at Klickitat Valley Health (WA), taught himself IT, started the hospital’s IT department, was assigned responsibility over other departments, and then was chosen to be CEO of the hospital. 

Sponsor Updates

• Black Book Research outsourcing services survey respondents recognize Dimensional Insight as the top outsourced analytics solution.
• First Databank’s FDB Vela e-prescribing network earns HITRUST risk-based, two-year certified status.
• Mobile Heartbeat announces that its cloud-based clinical communication and collaboration solution, Banyan, is now available on the Microsoft Azure Marketplace.
• Healthcare Growth Partners publishes a snapshot of the radiology software landscape, 2019-2023.
• KLAS Research recognizes Impact Advisors as a top provider of data and analytics services in its Data & Analytics Services 2023 report.
• Medicomp Systems releases a new “Tell Me Where It Hurts” podcast featuring Bob Taylor, DO, chief product strategies of TouchWorks EHR, Altera Digital Health.
• Meditech Lead Designers Tammy Coutts and Michael Shonty describe their work to advance disability inclusion within EHRs and to update the HIMSS Electronic Health Record Association’s Personas Library to include accessibility in recent HIMSS EHRA blogs.

Blog Posts

• Smart Coverage Detection Equals Better Patient Care + Stronger Bottom Line (EClinicalWorks)
• “Living Positive” Film: a Community of Hope, Brought Together by HIV (Findhelp)
• 3 Ways to Optimize Automation in Revenue Cycle Management (FinThrive)
• Is Data Migration to the Cloud Inevitable? (Five9)
• Navigating incident response: Lessons from a hospital cyber attack (Fortified Health Security)
• 5 Reasons Why Consistent Health Education is Important (Healthwise)
• Leadership Through Service: Our 2023 Social Impact Report (Healthcare IT Leaders)
• Empowering maternal and newborn health research with Inovalon data (Inovalon)
• Streamlining EMR Interactions with a Reimagined User Experience (InterSystems)
• Hiding in Plain Sight: Leveraging Existing Patient Data for Early Detection of Diabetes (Lucem Health)
• 3 Tips for Surviving the Holiday Emergency Department Rush (Medhost)
• How Cloud Technology is Changing the Face of Clinical Communication (Mobile Heartbeat)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 12/7/23

Researchers at Brigham and Women’s Hospital, Massachusetts Institute of Technology, Celero Systems, and West Virginia University have created a new ingestible device that can monitor vital signs such as respiratory rate and heart rate. The so-called Vitals Monitoring Pill uses an accelerometer to pick up small movements in the digestive system that occur each time the patient’s heart beats or they take a breath.

The device was initially validated in an animal model, then used for humans as part of a sleep study trial. Although the study was small with only 10 patients, researchers found that the data the device collected was comparable to that collected using standardized monitoring equipment. The study was also limited by the fact that participants were either sleeping or resting in a bed and the authors note there is the need to evaluate it in a more natural environment.

Researchers plan to focus on modifications that could keep the device in the digestive system for up to a week and to develop systems that could release medication in response to certain readings. They propose to be able to use it to detect opioid overdoses and treat them without external intervention.

From ShowMe: “Re: the state of Missouri. The last one in the nation to get on board with a prescription drug monitoring program (PDMP). For several years, in the absence of a state solution, the St. Louis County PDMP has been the de facto solution and other counties participated. Missouri is finally rolling out their solution next week, but users have been warned that they’ll have less functionality with the new solution. Way to go, technology.” I reviewed the materials forwarded by ShowMe and it looks like providers will lose the interstate sharing options they previously had through St. Louis County’s PDMP. Instead, they’ll have to separately register for access to neighboring states and use those individual state PDMPs to perform queries. Illinois requires that registrants of their PDMP have an Illinois controlled substance license, which many Missouri physicians may not have, so drug-seeking patients may be able to exploit the data gap. Additionally, not all counties have agreed to transfer their historical data from the St. Louis County solution to the state solution, so gaps will exist there as well. Physicians have been asked to “please keep this in mind when making clinical decisions. As a result, co-prescribing of naloxone with opioid prescriptions is recommended.” Technology is supposed to support clinicians rather than cause new issues, but I guess it’s to be expected when a state is dead last at doing the right thing. Missouri was one of the last states to bring up an immunization registry, if I recall correctly.

From Jimmy the Greek: “Re: return to office. My organization’s leadership has asked us to ‘practice’ working in the office. Having spent more than half of my career in an office, the idea that I need to practice coming to the office before I do it for real is insulting.” Jimmy’s screenshots made my head spin. Although I appreciate the company’s sentiment, there are ways to offer the same information without being patronizing. Despite this being a team of IT professionals, they were encouraged to come to the office for a “dry run” to test the wi-fi, headsets, and desks as well as to experience the parking arrangements and practice booking a conference room and eating in the company cafeteria. Additionally, employees were told to test their commute to evaluate travel time and traffic considerations, but gave no mention of the fact that hundreds of employees returning to the office are going to totally change the traffic patterns around the facility. As someone who has been a people manager in both remote and in-person situations, I’d like to think that managers know their people well enough to know who has worked in an office setting before and who might be at risk for issues or might require extra support. At a minimum, the organization could have offered a free meal to help entice employees back.

The Joint Commission has unveiled a new certification which will become available starting January 1. The Responsible Use of Health Data certification will evaluate hospitals across key areas including deidentification, data controls, data use, algorithm validation, patient transparency regarding deidentified data, and oversight structure for use of deidentified data. It will be interesting to see how organizations prepare their employees for this certification and whether clinicians will discover that there is so much more to using health data than they realize. I recently was in a spirited discussion with a clinician who had been ignoring a patient’s request for an amendment to their medical record. When the chair of the compliance committee and I informed the clinician that this was a violation under HIPAA, she said we were “full of crap, because no patient information was shared.” It had never occurred to her that HIPAA covers much more than information sharing, because the organization’s training had a narrow focus. A follow up survey to other clinicians revealed that 90% of them didn’t know patients had a right to request an amendment and 12% thought it was acceptable to just ignore patient portal messages. It looks like this organization has some work to do, not only in education, but also in fostering professionalism.

NorthShore-Edward-Elmhurst Health has rebranded itself as Endeavor Health as a follow up to the $5.3 billion merger that was responsible for its creation. The transition effort will include new names for its hospitals as well as updated employee uniforms, websites, and of course a social media campaign. Statements from leadership were around the “inspirational and aspirational” nature of the name, but when I hear it, I only think of the similarly named PBS program. I wonder how the cost of a health system rebrand compares with filming a gritty period drama, but suspect the latter has a better return on investment.

After considerable good-natured cajoling by younger colleagues, this blog marks my first attempt at trying to stop using two spaces after a period. As someone who is in my fourth decade of touch typing and who learned on the venerable IBM Selectric, I can attest that it’s hard to learn new tricks. Objectively, the process change added frustration and reduced my typing speed significantly, but I found the mental overhead to be the worst. I think I’ll go back to the old ways that will die with me, along with the use of handwritten thank you notes, formal invitations, and knowing how to set a table to accommodate a five-course meal.

One space or two? Is it worth it to try to eliminate the extraneous keystroke? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/7/23

R1 RCM to Acquire Acclara

Multistate health system Providence sells its Acclara RCM business to R1 RCM for $675 million, and enlists R1 to provide revenue cycle services.

HHS Announces Next Steps in Ongoing Work to Enhance Cybersecurity for Health Care and Public Health Sectors

HHS expands its efforts to help providers improve cybersecurity with a new concept paper that includes plans to offer financial cybersecurity assistance to hospitals.

Fountain Life Acquires Health Data Technology Company LifeOmic to Power its Advanced Diagnostics and Membership Services

Membership-based precision diagnostics and therapeutics company Fountain Life acquires precision digital healthcare company LifeOmic for an undisclosed sum.

Healthcare AI News 12/6/23

News

Google announces Gemini, an “everything machine” competitor to ChatGPT that offers little new functionality to wow users, but puts AI’s key features into a single package. The company will license Gemini to Google Cloud developers and will integrate it starting this week in Google’s consumer-facing apps such as the Bard chatbot, Gmail, and YouTube.

Business

China-based AI drug discovery company XtalPi, which has raised $732 million in funding at a valuation of $2 billion, files for an IPO on the Hong Kong exchange. The three founders are MIT quantum physicists.

The Wall Street Journal reports that drugmaker Johnson & Johnson has hired 6,000 data scientists and spent hundreds of millions of dollars on AI drug discovery technology.

Research

A study finds that ChatGPT incorrectly or incompletely answered 75% of the drug-related questions that were posed to a pharmacy school’s drug information service. It also generated fake citations when asked to list its references. The authors warn that users should check its results against trusted sources.

Other

An op-ed article in Nature says that healthcare institutions should proceed cautiously in rolling out off-the-shelf proprietary large language models from “opaque corporate interests” to avoid undermining the care, privacy, and safety of patients by using tools that are hard to evaluate or could be changed or taken offline. The authors urge a more transparent and inclusive approach in which health systems researchers, clinicians, patients, and tech companies collaborate to build open source LLMs.

The American Veterinary Medical Association describes how one member is using AI to provide a second opinion on X-ray interpretation and to record visit conversations and turn them into SOAP notes.

Microsoft research VP Peter Lee, PhD provides thoughts about AI in healthcare:

• It won’t be long before doctors will refuse to practice medicine without the assistance of AI.
• Bing and ChatGPT are good at deciphering lab test results and explanation of benefits, where they can be asked “are any of these results concerning“ or “do I owe money.”
• He and his sisters asked GPT-4 to review their father’s medical records, then list the three best things to ask the specialist in their 15-minute visit.
• He says that GPT-4 is “almost superhuman” in its ability to serve as a second set of eyes for a physician in reviewing patient information and the doctor’s diagnosis by being asked, “Did I miss anything, or should I consider something else?”
• Lee warns doctors not to think of ChatGPT as a computer that has perfect recall and performs perfect calculations, but rather as a “personal intern” whose work requires review.
• AI doesn’t follow the regulatory framework of a software medical device, so it’s up to the medical community to take control of how and when it it used.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Readers Write: Five Takeaways from The Sequoia Project’s Annual Meeting

Five Takeaways from The Sequoia Project’s Annual Meeting
By John Blair, MD

John Blair, MD is CEO of MedAllies of Fishkill, NY.

I recently attended the annual meeting in San Diego of The Sequoia Project, a non-profit that advocates for health IT interoperability, and was impressed with the spirit of collaboration and optimism as stakeholders look forward to taking the next steps toward making interoperability a reality.

Without a doubt, interoperability has been a top-of-mind subject for many years for many of us in attendance, but the issue has gained renewed focus recently, as Qualified Health Information Networks (QHINs) are poised to launch.

QHINs are an essential component of The Trusted Exchange Framework and Common Agreement (TEFCA), a new regulation backed by the federal government and intended to improve interoperability. TEFCA’s goal is to establish a universal floor for interoperability across the country by developing the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other.

In addition to QHINs, other key issues discussed included: interoperability use cases, the benefits of Fast Healthcare Interoperability Resources (FHIR), the unique challenges to health information exchange for public health, and how today’s patient experience can be improved leveraging existing technology and investments.

My five biggest takeaways include:

1. QHINs will be quickly migrating customers from their current networks to the new QHIN networks.
2. Although QHINs will be competing for customers, they plan to cooperate with each other as the networks become operational. They understand that a network of networks is only as good as the weakest network, and it’s essential that they help and support one another in day-to-day operations. Without cooperation, customer support will suffer and the overall success of QHINs will be at risk.
3. Interoperability stakeholders are anxious to get the current uses up and running. These use cases include treatment, individual access services, payment, health care operations, public health, and government benefits determination.
4. Although the treatment use case has been active for many years, there is still work to be done around data quality, quantity, and end-user workflow.
5. Data usability is set to take center stage. A plethora of health data is already being exchanged, but its value is often limited due to issues with normalization, fragmentation, and usability. QHINs will help solve these limitations by driving greater accuracy and completeness of patient health data.

Open questions remain regarding the ultimate effect that TEFCA and QHINs will have and their ability to generate nationwide interoperability improvements. However, the energy and enthusiasm that were palpable at the Sequioa Project’s annual meeting will likely fuel efforts to overcome inevitable roadblocks as stakeholders work to address current and future regulations and advance efforts to increase the volume and utility of health information exchange.

Morning Headlines 12/6/23

CVS To Rebrand Growing Health Services As ‘CVS Healthspire’

CVS Health will use the name CVS Healthspire for its health services business that includes Oak Street Health, Signify Health, MinuteClinic, Caremark, and its recently created biosimilar company Cordavis.

Tower Health laid off 30 people on Tuesday

Tower Health (PA) lays off 30 employees and outsources some of its IT department to an outside vendor.

Army veteran files lawsuit alleging VA computer system delayed cancer diagnosis

A Mann-Grandstaff VA Medical Center (WA) patient sues the federal government and the companies responsible for the development of the center’s Oracle Health-based EHR over alleged flaws in the system that led to a delay in his now-terminal cancer diagnosis.

News 12/6/23

Top News

CVS Health will use the name CVS Healthspire for its health services business that include Oak Street Health, Signify Health, MinuteClinic, Caremark, and its recently created biosimilar company Cordavis.

The company is following the lead of competitors that offer both health insurance and health services, such as UnitedHealth Group (Optum), Cigna (Evernorth Health Services) and Elevance Health (Carelon).

CVS also announced that its pharmacy pricing formula will change to a more transparent cost-plus model, following the lead of Mark Cuban’s Cost Plus Drugs.

Reader Comments

From Joy DiVive: “Re: North Carolina’s NCCARE360. A non-profit human services organization says that that weaknesses in Unite Us’s referral platform is the biggest threat to the $24 million Healthy Opportunities Pilot as funded by federal taxpayers.” Verified, per the communication that HSO Reinvestment Partners sent to the state complaining of poor invoice tracking, deficiencies in protecting confidential patient information, deficient case tracking, and the inability to upload and export data. That’s one organization’s opinion, anyway.

From Ellipse: “Re: CareRev. Another reduction in workforce today, about one-fourth of the company.” Unverified. The nurse shift-bidding platform reportedly laid off 100 employees, about one-third of its headcount, in June. The decreased use of gig clinicians post-COVID was a problem, unnecessarily enhanced by the loose lips of the now-departed co-founder and CEO who told co-workers of his love for microdosing LSD.

From Tick Tock: “Re: Oracle Health. Have they lost interest in the VA or in healthcare in general? None of the promised improvements have been delivered and the company no-shows congressional hearings.” Either they are focusing on basic blocking and tackling with the VA or they have lost interest as the project struggles. Oracle closed its Cerner acquisition in June 2022, and after some initial lofty healthcare pronouncements from Larry Ellison, most of the news since has involved layoffs, an expressed fervor to milk Cerner’s profits harder in a provider climate where that will be difficult, and selling unrelated Oracle products to health systems. They were supposed to rewrite Millennium, deliver a new pharmacy system to the VA by April 2023, and switch to a voice-first user interface. The company also promised to grow Cerner’s community presence in Kansas City, which has gone the other way. It will get ugly if the VA can’t get its implementations going again or if ORCL shares tank for unrelated reasons and all-important investors demand a quick turnaround. Their best hope, given Oracle’s army of lobbyists, would have been federal government, except that not much is left after bagging DoD, VA, Coast Guard, and IHS. Second best hope is overseas sales, although Epic is growing in the most attractive areas. The company promised a couple of big sales this quarter that added up to $1 billion, although much of that may come as subcontractor to General Dynamics for the $2.5 billion Indian Health Service contract.

HIStalk Announcements and Requests

Generous donations from Michael and Natalie, matched with funds from multiple sources including those from my Anonymous Vendor Executive, fully and anonymously funded these Donors Choose teacher grant requests:

• Headphones for Mr. S’s elementary school class in San Antonio, TX.
• STEM and engineering tools for Ms. T’s elementary school class in Waluku, HI.
• Science materials for Ms. M’s high school class in Homestead, FL.
• Math supplies for Ms. C’s elementary school class in Peoria, IL.
• Books for the computer science lab of Ms. C’s elementary school in Revere, MA.
• Math workbooks for Ms. A’s elementary school class in Spring Valley, CA.
• Headphones for Ms. F’s elementary school class in San Diego, CA.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

KONZA National Network and the Kansas Department of Health and Environment are piloting the use of real-time alerts for incoming or transferred patients who are actively diagnosed with multi-drug resistant organisms. The alerts are delivered directly to a provider’s EHR in less than five minutes using Direct Secure Messaging, allowing immediate isolation and implementation of transmission-based protocols. 

Sales

• UofL Health (KY) will implement Verato’s healthcare master data management software to help improve identity management across its system.
• Emory Healthcare (GA) will use Nference’s Nsights de-identified patient data technology to support its research in several therapeutic areas.

People

Children’s Hospital Colorado promotes Amy Feaster to SVP/CIO and chief digital officer. She replaces Dana Moore, who will retire at the end of the month.

Ric Downs (Veris Health) joins Fuse Oncology as VP of sales.

Amenities Health names Scott Heatherly (Hyro) VP of sales.

Stanford University medical school professor and Stanford Health Care radiology informatics director Curtis Lanlotz, MD, PhD is named president of RSNA. He earned his medical degree, master’s in AI, and doctorate in medical information science from Stanford.

Announcements and Implementations

Ireland’s National Forensic Mental Health Service goes live on InterSystems TrakCare.

Government and Politics

HHS will name the initial group of Qualified Health Information Networks in a livestreamed QHIN Designation Ceremony next Tuesday at 9:00 a.m. ET.

Politico says that members of Congress are concerned that Google is using advanced AI in healthcare before the government has created guidelines for such use, with particular concerns about patient privacy. The article notes that Google is hiring former federal healthcare regulators —  such as former National Coordinator Karen DeSalvo, MD, MPH, MSc and several former FDA officials — and is raising the concerns of startups that its deep pockets will squeeze smaller companies out.

Privacy and Security

Seattle-based Fred Hutchinson Cancer Center announces that it was the victim of a cyberattack just before Thanksgiving.

The Rhysida ransomware gang claims responsibility for a ransomware attack on London’s King Edward VII Hospital. The hackers allege that some of the stolen data, which they’ve threatened to put up for sale online, includes information pertaining to the British royal family. Hospital officials, on the other hand, insist that only a limited amount of “benign hospital systems data” was copied from its IT system.

Other

UCLA Health researchers find that 20% of patients whose electronic medical data showed them as suffering from serious illness were in fact dead. Researchers analyzed the health data of 11,700 patients across 41 UCLA Health clinics over two years, then compared it with data from California’s Department of Public Health Public Use Death File. A state law prohibits death file data from being shared with healthcare institutions, resulting in what the researchers deem “wasteful outreach that strains resources and healthcare workers’ time.” The authors say the problem could be easily solved if the state didn’t restrict death record sharing except for financial institutions.

A fascinating LinkedIn post by Chris Deacon, JD questions how big-brand, non-profit health systems (Cleveland Clinic, Brigham) are allowed to accumulate billions of dollars in hedge funds and overseas investments – generated from US tax breaks, astronomical patient charges, and charitable donations – to build massive medical palaces in London, UAE, and China. She calls for non-profit health systems to account for their international spending given that their local communities are footing the bill even as services to those local communities are curtailed or to overloaded to book. A comment by my favorite curmudgeon Matthew Holt speculates that big health systems hold $250 billion in hedge funds, with another $250 billion owned by non-profit insurers like BCBS and Kaiser Permanente.

Sponsor Updates

• Nordic releases a new Designing for Health Podcast, “Interview with Billy Nicolich.”
• Agfa HealthCare recaps its time at RSNA with daily updates.
• AvaSure publishes a new whitepaper, “Roadmap to virtual nursing: How UCHealth scaled its program and saved lives.”
• The HLTH Matters Podcast features Bamboo Health Chief Clinical Innovation Officer Nishi Rawat, MD.
• The Safeopedia Podcast features Bardavon Chief Clinical Officer Dorothy Riviere and VP of Injury Prevention Scott Coleman, “Revolutionizing Workplace Safety: The Power of Tech-Enabled Safety Cultures.”
• Black Book Research’s latest user satisfaction survey ranks MedEvolve as the leading vendor for RCM workflow optimization and automation services.
• Censinet releases a new Risk Never Sleeps Podcast, “The Key to Job Fulfillment: Autonomy, Complexity, and Reward, with Matt Christensen, Senior Director Cybersecurity at Intermountain Health.”
• ConnectiveRx releases a new podcast, “Empowering Communities: Pharmacists’ Crucial Role in Patient Health.”
• Dimensional Insight will sponsor the Massachusetts Health & Hospital Association’s Annual Women Leaders in Healthcare Conference December 7 in Waltham.
• Divurgent releases a new episode of The Vurge Podcast, “Coming Together for Women in HIT and Cybersecurity.”
• DrFirst publishes a new case study, “Cone Health Finds Medication History for 93% of Patients by Connecting with Local Pharmacies and Leveraging AI.”

Blog Posts

• Help Your Patients Pay Less for Their Prescriptions (AdvancedMD)
• Underpaid Claims: Navigating the Challenges (AGS Health)
• Future-forward healthcare: Data platform considerations (Arcadia)
• Digitize Medical Billing for Atypical Providers with Quick Claims (Availity)
• Advancing Health Equity: The Role of AI in Healthcare and Clearsense’s Approach to Value-Based Care (Clearsense)
• Why is Documentation Important in Healthcare? (Consensus Cloud Solutions)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 12/5/23

Gemspring Capital Announces Sale of Valant

Gemspring Capital sells mental health-focused EHR and practice management software company Valant Medical to private equity firm Resurgens Technology Partners.

Digital Health Strategies Closes Series A Funding Round to Expand Its Share of Health Patient Loyalty Platform

Digital Health Strategies, a patient loyalty and healthcare marketing firm based in Washington, DC, secures an undisclosed amount of Series A funding.

Notice of information security incident involving Fred Hutchinson Cancer Center

Seattle-based Fred Hutchinson Cancer Center announces that it was the victim of a cyberattack just before Thanksgiving.

Curbside Consult with Dr. Jayne 12/4/23

I was invited to yet another retirement party this week. It was again for a primary care physician who is leaving medicine at an age that is decidedly less than the oft-discussed 65.

Burnout played a role in every retirement gathering I’ve attended over the last couple of years. It’s sad to see so much knowledge and experience leaving the field. More than half of these physicians would have been interested in continuing to practice part time, but it sounds like their corporate employers weren’t terribly interested in trying to make that happen. The practices they left continue to be slammed and have wait lists for new patient appointments that are several months long.

Most of my local primary care physician peers are a number of years away from being able to retire. I struggle to think of one colleague who isn’t suffering from some degree of burnout.

When asked what might help the dumpster fire that is healthcare in the US, quite a few cite artificial intelligence as the answer. Just use ChatGPT to write your prior auth letters! Or insurance appeals! Or letters for emotional support animals, educational modifications for school-aged patients, Family and Medical Leave Act documents, and more! The enthusiasm that people voice about these solutions seems to be contagious, but it’s rare that those who are using it fully understand the risks of feeding protected health information into different solutions, or that they can be liable if they’re allowing staff to use AI solutions for patient management but aren’t doing 100% review of the output.

With this in mind, I was excited to read a special communication in last week’s Journal of the American Medical Association titled “Will Generative Artificial Intelligence Deliver on Its Promise in Health Care?” If the title alone wasn’t enough to catch my attention, seeing Dr. Robert Wachter listed as the first author definitely helped.

Wachter and his co-author Erik Brynjolfsson note that historically, it usually takes many years for technologies to deliver promised benefits. Because healthcare is such a complex environment, this can make the incorporation of new technologies even more challenging. They go on to say that generative AI is different, though, and has “unique properties that may shorten the usual lag between implementation and productivity and/or quality gains in health care.” They also note that not only are health organizations more receptive to the technology, but that many “are poised to implement the complementary innovations in culture, leadership, workforce, and workflow often needed for digital innovations to flourish.”

The latter is an interesting point, especially since I’m often working with organizations that struggle to implement “innovations” that are more than a decade old. These solutions may not be heavy on technology, but are often fairly straightforward people and process adjustments that have the potential to improve patient care, reduce staff and clinician frustration, and create more efficient interactions in the healthcare system. Often they are relatively inexpensive to implement, but require the sometimes elusive stakeholder alignment in order to bring them to fruition.

Given all the buzz around AI-related solutions, I’m starting to wonder whether we can slap a label on them that says “AI-driven” and use that as a way to convince people to take some steps towards making their organizations run more efficiently.

Turning back to the JAMA article, some interesting facts jump out. First, nearly one-third of the $4.3 trillion that is spent in the US each year adds little to no value. I’ve seen that first hand in the urgent care trenches, where patient demand for testing and imaging studies often overshadows the physician’s judgment, particularly when an organization places a high value on patient satisfaction scores. Clinicians are trained to use a variety of clinical decision support rules to determine whether someone needs an x-ray after injuring their ankle, or whether a child needs an imaging study when they fall off their bed. However, insistent patients or parents may push or escalate, resulting in thousands of dollars in healthcare spending that could have been avoided.

It feels like we’re rarely able to make clinical diagnoses anymore, relying on the history, exam, and our education and training. Instead, we have to perform laboratories to prove ourselves sometimes, even when the answer is very straightforward. One organization I worked at pushed clinicians to order unneeded medications that could even be harmful, in the guise of “patient satisfaction.” Needless to say, I frequently wound up on the wrong side of that organization’s quality reports, but at least I had my integrity.

Second, preventable harms are still a major problem in the US, with tens of thousands of deaths happening each year due to situations that could have been mitigated. These range from simple medical errors that might be prevented with the application of basic technology (such as allergy warnings that appear when medications are prescribed) or complex errors that result from multiple failures along the way. Those can be particularly hard to work through as a clinician, since there are often many steps where the problem could have been prevented, but the system failed regardless. Electronic health records were initially seen as a solution to these difficult situations, but some days it feels like they have created two new problems for every one that they solved.

The article goes in depth to describe “the productivity paradox of information technology,” where technologies fail to deliver value. One main reason for this is the flawed nature of many early versions of technologies and the need to have multiple iterations before a successful tool is achieved. The second reason, which the authors view as more important, revolves around “the processes, structure, and culture of the workplace.” I felt validated when reading that sentence since I’ve lived it so often while trying to help organizations with their clinical transformation initiatives. The authors note the need to often have multiple complimentary innovations to overcome the productivity paradox. It’s another way of saying that no silver bullet exists for solving a difficult problem.

They go on to explain some of the “particular challenges” of implementing technology in healthcare. These are the factors that so many companies fail to understand as they promise to fix healthcare or revolutionize the patient experience. These challenges include the highly regulated nature of healthcare, differing opinions on data ownership, the need to protect patient privacy, and the fact that all these factors at times interfere with each other.

They go on to list other challenges, including the fact that the EHR market is highly concentrated with only a few major players left. In contrast, parts of healthcare have a plethora of players, including clinicians, care delivery organizations, payers, employers, pharma, device vendors, government, and more. As such, new technologies are likely to progress when they can make improvements for multiple stakeholders rather than for just one subset of players in the industry.

Other challenges that they list include the fact that healthcare data can be messy depending on where it comes from (billing, clinical documentation, compliance) and that healthcare is constantly evolving, often through research and changes in practice. As such, AI tools that are based on historical patient data may not be applicable in the present and in fact might be dangerous.

Last, they note that healthcare is high stakes, with the very real impact on patients making it potentially harmful to do the “fail fast and iterate” approach that happens in other technology environments. We’ve all seen innovations that harm patients, whether it’s an inadequately studied drug, a faulty medical device, or an improperly implemented clinical decision support tool.

Despite the fact that previous AI technologies haven’t delivered, (IBM Watson, anyone?) the authors see several factors that may lead to improved solutions this time around. They cite the relative ease of use of generative AI as a positive, along with the fact that the technology can be delivered to users easily through devices they’re already using. The ability to interact with new solutions via application programming interfaces (APIs) is also a plus, as is the speed of evolution of the generative AI solutions themselves.

The authors believe that healthcare leaders are better prepared to consider workflow redesign than their predecessors, in part due to the presence of clinical informaticists (yay!) and those with experience in user-centered design. They feel that leaders have learned from past failures as well. They mention the irony that many of the problems that were created by prior digital innovations – such as documentation burden and the EHR inbox – may be addressed by new generative AI powered tools, which would be a lovely thing for all of us.

It will be interesting to revisit the premises of this article after we’re six months or a year down the road. Maybe by the time generative AI reaches its second birthday, we’ll be living in a world of smoother patient care, streamlined communications, and improved clinical quality, all thanks to the wonders of artificial intelligence. It’s more likely, though, that major improvements will still take years, but at least that will be faster than the decades of inertia we’ve all been living in.

The authors call on AI developers to address elements such as bias, safety, cost, and hallucinations. They note that regulators need to develop standards that promote innovation as well as safety. They state that most important is for healthcare leaders to “prioritize the areas where genAI can create the greatest benefits for their organizations, paying close attention to those complementary innovations that remain necessary and striving to mitigate the known problems with genAI and any unanticipated consequences that emerge.”

What do you think about the role of generative AI in coming years? Are we on the cusp of greatness, or heading down the road to ruin? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/4/23

Culmination Bio Raises $10M From Amgen Ventures and Merck Global Health Innovation Fund to Bring Longitudinal Health Data to Biopharma

Intermountain Health spinoff Culmination Bio, which offers drug companies a clinical study recruitment platform that contains 40 years’ worth of de-identified EHR and biospecimen data, raises $10 million from two drug company investment funds.

Potrero Medical Announces Restructuring and Continued Operations

Potrero Medical, which offers medical devices and analytics for monitoring acute kidney injury, files Chapter 11 bankruptcy.

Hippocratic AI Launches Early Access Partnership Program With Leading Healthcare Organizations Including OhioHealth, Roper St. Francis Healthcare, Evernow, HarmonyCares, and Guidehealth

Hippocratic AI launches a development partnership program that includes OhioHealth, Roper St. Francis Healthcare, Evernow, HarmonyCares, and Guidehealth.

Monday Morning Update 12/4/23

Top News

Intermountain Health spinoff Culmination Bio, which offers drug companies a clinical study recruitment platform that contains 40 years’ worth of de-identified EHR and biospecimen data, raises a $10 million investment from two drug company investment funds.

Reader Comments

From Spangler: “Re: physicians in rural areas. It’s concerning that we are facing a shortage even if telemedicine and AI try to help.” The real issue is that the dismal conditions of working as a corporate physician are driving many away from patient care or out of medicine. This exodus is tempered only by the need to repay massive school loans. It’s worth reconsidering the necessity of an eight-year education plus internships and residencies for primary care physicians (PCPs) that push their career entry into their late 20s or early 30s. Alternatives could include expanding the roles of nurse practitioners, physician assistant, and pharmacists. Additionally, integrating AI into medical training could accelerate training, especially given the rapid obsolescence of classroom work, and could be used to provide support as needed for more unusual cases. Meanwhile, the profit-obsessed US healthcare system is increasingly strained as major physician employers compete for the essential yet limited clinical workforce.

From Poppy: “Re: ChatGPT 4 Plus or Pro. You can now add any file type and it will analyze and even visualize the data for you. I’ve used it to sort DEI survey responses as either friendly or antagonistic and it works like a charm.” ChatGPT keeps adding features to the point I can’t keep up. I use custom instructions to ask it to include source links as well as its numeric confidence rating of its response, both of which are helpful. I’ve also upload images and files and asked it to perform simple functions, although I’m still using it mostly to analyze writing or to generate ideas, and while I wouldn’t call it mission-critical to my work, it’s getting there. I would like to hear from readers – what are some less-than-obvious ChatGPT capabilities that you are using to get work done? I’m still anxiously awaiting an easily installed, inexpensive chat/search function that would provide a front-end for searching HIStalk, which contains everything important that has happened in health IT since 2007.

HIStalk Announcements and Requests

The biggest PCP frustration among poll respondents by far is trying to book an appointment.

New poll to your right or here: How would you grade health IT conferences on their level of presenter diversity? An additional question that is more for commentary than polling – should conferences be held accountable for offering a diverse roster of presenters and panelists when the underlying cohort mostly involves white males? 

Generous donations from Karen, Bill, another Bill, and Mike, with matching funds from third parties and my Anonymous Vendor Executive, fully and anonymously funded these Donors Choose grant requests from teachers who are working in historically underfunded schools:

• A math book series for Ms. K’s middle school class in Fort Stockton, TX.
• STEM station materials for Mr. G’s middle school class in Greenacres, FL.
• STEM activity kits for Ms. G’s elementary school class in Baltimore, MD.
• A lectern for Mr. P’s high school class in Pharr, TX.
• Headphones and math manipulatives for Mr. W’s elementary school class in North Las Vegas, NV.
• Math games for Ms. C’s elementary school class in Jamaica, NY.
• A coding robot and math manipulatives for Ms. K’s elementary school class in Orlando, FL.
• Headphones for Ms. M’s middle school class in Glendale, AZ.
• Home health aide training books for Ms. W’s high school class in La Jara, CO.
• A bilingual STEM center for Ms. R’s elementary school class in Las Cruces, NM.
• Headphones for Mr. S’s elementary school class in Yonkers, NY.
• Headphones for Ms. K’s elementary school class in Tyler, TX.
• Science books for Ms. S’s elementary school class in Natchez, MS.
• STEM books for Ms. P, a librarian at a middle school in Coffeyville, KS.
• An achievement button making machine for Ms. E’s high school class in Goodyear, AZ.
• Books for Ms. K’s high school class in Bronx, NY.
• STEM development activities for Ms. F’s elementary school class in Indian Orchard, MA.
• STEM model building kits for Ms. W’s elementasry school class in South Ozone Park, NY.
• Programmable robots for Ms. J’s elementary school class in San Diego, CA.
• Headphones for Mrs. H’s elementary school class in Kinston, NC.
• Classroom supplies for Ms. G’s elementary school class in Mission, TX.
• Accelerated reading and anti-racism books for Ms. H’s elementary school class in Shreveport, LA.

You can do these things to support HIStalk:

• Join my spam-free mailing list.
• Connect on LinkedIn and join Dann’s HIStalk Fan Club, which tells me when you change jobs and gives you Swiftie-level influence points for favors asked.
• Tell my sponsors, or potential ones, that you value their support of what I do.
• Share news, rumors, and intriguing insights.
• Consider being interviewed if you are full of brash, eminently quotable expertise.
• Companies, consider booking my Top Spot Ad that lords over the entire HIStalk page and earns a commensurate number of reader clicks.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Hippocratic AI launches a development partnership program that includes OhioHealth, Roper St. Francis Healthcare, Evernow, HarmonyCares, and Guidehealth.

Potrero Medical, which offers medical devices and analytics for monitoring acute kidney injury, files Chapter 11 bankruptcy.

Announcements and Implementations

Black Book posts results from its healthcare cybersecurity satisfaction analysis, with the overall KPI leader being CrowdStrike. The report concludes that cybersecurity solutions that were purchased before the beginning of 2023 may already be outdated in their ability to protect against hacks and breaches, with remote patient access systems and telehealth offering new entry points for cyberattacks. 

Sponsor Updates

• Netsmart takes first and third place among 115 teams that competed in the AWS re:Invent Jam.
• Nordic expands its partnership with Fortified Health Security to strengthen security operations and deploy global response capabilities for customers.
• Wolters Kluwer Health expands its Sentri7 clinical surveillance suite to include the Sentri7 Drug Diversion solution, formerly Flowlytics from Invistics.
• Gartner names NTT Data a Leader in its 2023 Magic Quadrant Managed Network Services and a Leader in its 2023 Magic Quadrant Network Services, Global.
• Nuance shares success stories from early adopters using its PowerScribe Smart Impression generative AI solution for radiology reporting.
• Nym names Hen Sinai junior backend engineer, Adi Sivan software engineer, Yuval Shtechman medical data analyst, Barbi Elmore director of product, Zack Hechtman customer success associate, and Yuval Tov junior backend engineer.
• Rhapsody announces a long-term partnership with Blackford Analysis to enhance Blackford’s medical AI solutions platform by providing deeper clinical workflow integrations.
• RxLightning names Christopher Hemminger cloud data architect and Karen Outlaw project manager.

A Black Book Market Research survey of top cybersecurity customers ranks solutions according to highest user satisfaction. HIStalk sponsors include:

• Clearwater – cybersecurity advisors and consultants / compliance and risk management solution.
• Fortified Health Security – cybersecurity awareness training and education.
• CloudWave – outsourcing and security networked managed services.
• PerfectServe – secure communications platforms: physician practices
• Spok – secure communications platforms: hospitals and health systems.

Blog Posts

• How Technology Can Help Providers Get Paid and Common Challenges (CereCore)
• Two years later – what one hospital on Cerner learned from automating intake, registration, authorizations and more (Notable)
• How University of Michigan Health-West improved clinician wellbeing (Nuance)
• The Growth Equation – Boosting Your Operations to Scale for Growth (Netsmart)
• Before implementation, think about prehabilitation (Nordic)
• How Patient Journey Mapping Improves the Patient Experience (PerfectServe)
• Up in the Cloud: Future-Proofing Healthcare Data with Productive Edge and Redox (Redox)
• How Healthcare Organizations Can Offset the Labor Shortage with Sensing-as-a-Service (SmartSense by Digi)
• Supply Chain Experts Explore Top Priorities for Healthcare in 2024 (Symplr)
• Navigating SupportCaregiving.org: Insights and Federal Strategies on Caregiving (Trualta)
• Waystar Advisory Board: 5 takeaways from our inaugural True North conference (Waystar)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 12/1/23

Cigna, Humana in Talks for Blockbuster Merger

Health insurers Cigna and Humana are negotiating a merger that they hope to finalize within the next four weeks, according to insider reports.

Experian Health Acquires Wave HDC, Immediately Enabling Real-Time, Single Inquiry Insurance Discovery/Verification at the Point of Patient Registration

Experian acquires Wave HDC, which captures patient insurance and demographics at registration.

HFMA Aligns with FinThrive to Introduce the Industry’s First Revenue Cycle Management Technology Adoption Model for Health Systems

HFMA and FinThrive launch a peer-reviewed, five-stage Revenue Cycle Management Technology Adoption Model, with initial analysis indicating that 42% of health systems are at Stage 1.

News 12/1/23

Top News

Health insurers Cigna and Humana are negotiating a merger that they hope to finalize in the next four weeks, according to insider reports.

The companies are sure to face anti-trust challenges as they did in their failed 2015 merger attempt.

Humana focuses on Medicare Advantage plans, while Cigna recently announced its intention to exit that business to focus on its pharmacy benefit and commercial insurance offerings.

The value of the combined companies would approach $140 billion. Cigna and Humana shares dropped on the news.

Reader Comments

From Ex-HHC: “Re: Donors Choose. Can you re-post donation instructions?” I will, while adding that while I use the term “my Donors Choose project,” I don’t actually have a project and I don’t actively bug readers to support one (that constitutes “virtue signaling,” as one cynical reader stung me with). It’s a great cause in which you are donating directly to Donors Choose, I apply matching money from my Anonymous Vendor Executive, and I fully and anonymously fund STEM-related teacher projects of my choosing as that person requests. Above is a photo from Ms. D, whose Ohio middle school class has already received a tablet and 30 sets of headphones courtesy of Mark’s donation just two days ago. Anyway, long story short (too late):

• Purchase a gift card in the amount you’d like to donate.
• Send the gift card by the email option to mr_histalk@histalk.com (that’s my Donors Choose account).
• I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
• I’ll pool the money, apply all matching funds I can get, and publicly report here the projects I funded, including occasional teacher follow-up messages and photos.

From Litany of Brittanys: “Re: winter holiday. What was that one you mentioned last year?” That holiday is Yalda, which falls on December 21. Below is my explanation from last year, but I’ll also throw in an interesting and slightly related factoid — while the winter solstice signifies the fewest hours of daylight for those of us who are north of the equator, the earliest sunset occurs on December 8, for reasons that are too astronomically complicated to explain here. Back to Yalda:

Yalda celebrants, most of them in Iran and nearby countries, observe the winter solstice, the last day of autumn and the longest night of the year, after which hours of daylight start increasing again. People stay up all night, eat watermelon and pomegranates (their glowing colors symbolize dawn and life), read poetry, and dance and play drums when the sun rises in a triumph of light over dark. Yalda means “birth.” I like it even beyond my personal obsession with changing hours of daylight — nobody is excluded or favored since the same sun shines down on us all, although I suppose folks in the Southern Hemisphere would need to buy their Yalda pomegranates in June.

HIStalk Announcements and Requests

I’m getting inquiries lately from companies that want to pay me to do a video interview or podcast with an executive, highlight their product, or feature their press release. Other sites do this without disclosing the paid arrangement, they say, so they seem surprised when I tell them that my integrity isn’t for sale. I appreciate the interest, but it’s a no.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

Meanwhile, a KFF article notes that some hospitals are dropping their acceptance of Medicare Advantage plans — even as seniors more frequently choose that alternative to traditional Medicare — because of low and late payments and bureaucratic approval and denial processes. This could be a significant issue because it isn’t easy for a consumer to switch from an MA plan to traditional Medicare with a Medigap policy, potentially leaving them insured but with no in-network hospital nearby.

Experian acquires Wave HDC, which captures patient insurance and demographics at registration.

Stat’s Bob Herman notes that UnitedHealth Group’s Optum Health provider division now employs 90,000 physicians, up from 70,000 one year ago.

Mayo Clinic will spend $5 billion to redesign its Rochester campus that features “health neighborhoods” that are more convenient for extended care and for patients who have multiple health issues. Technology will play a key role, Mayo says. The plan is built around Rochester’s “Destination Medical Center” 20-year economic development plan, not that US healthcare wasn’t already confusing enough to the rest of the developed, longer-lifespan world without hinging regional growth on selling medical services.

People

PeriGen hires John Parker, MD (OhioHealth) as chief medical officer.

Announcements and Implementations

Duke Health begins its use of Microsoft Copilot, with IT employees developing Microsoft 365 use cases involving email management, editing and creating documents and presentations, and creating summaries of virtual meetings.

St. Joseph’s / Candler Health System (GA) goes live on Meditech Expanse ambulatory and launches implementation of Expanse Oncology.

HFMA and FinThrive launch a peer-reviewed, five-stage Revenue Cycle Management Technology Adoption Model, with initial analysis indicating that 42% of health systems are at Stage 1.

HIMSS announces Alabama football coach Nick Saban as the HIMSS24 closing keynote speaker, trying to pre-refute “any willing celebrity” smirks with the dubious explanation that there exist “so many parallels from football to healthcare.” I’ll consider this as validation of my decision to skip attending the boat show for the first time in forever. The HIMSS24 exhibitor count is at 483 versus the 1,216 of HIMSS23, which suggests either exhibitor procrastination or a disastrous drop under conference operator (or is it owner?) Informa Markets.

A new KLAS report on PACS finds that 20% of health systems plan to replace their systems in moving from legacy systems and moving toward enterprise imaging strategies. Sectra leads by far in purchase energy due to peer recommendations, strong customer relationships, and EHR integration, although cost considerations sometimes discourage smaller organizations. Visage Imaging’s cloud-based diagnostic viewer is gaining momentum among large health systems who like its radiologist-friendly user interface and strong integration, although its recently introduced vendor-neutral archive has seen limited adoption. (click the image to enlarge).

Other

A survey finds that 72% of consumers are unable or unwilling to pay their medical bills immediately, two-thirds of them because of money problems. Half of the respondents say they have postponed care and prescription fills due to cost, while one-third have no confidence in their ability to pay a medical bill over $500.

Tech expert Robert Scoble highlights how a Texas prison is using AI mental health conversation analysis software from Savantcare to address the 1,300 inmates who are being unconstitutionally held because they can’t mentally understand the charges they face.

Sponsor Updates

• Health Data Movers announces a strategic partnership with Workday as a certified Workday Advisory Services Partner.
• CHIME selects Meditech vice chair Howard Messing for its CHIME Foundation Industry Leader Award.

Blog Posts

• The Sequoia Project Annual Meeting Recap: This Event Was FHIR! (HealthMark Group)
• Unlocking the full picture of patient care: The power of linked, comprehensive, and actionable insights (Inovalon)
• Get Proactive About Security with Malware Emulation (Keysight Technologies)
• From Data to Decision: How AI Streamlines Early Identification of Those at Highest Risk of Progression from Prediabetes to Type 2 Diabetes (Lucem Health)
• 5 Reasons Why Offering Online Bill Pay is a Game Changer for Your Healthcare Facility (Medhost)
• Maximizing data at Palo Pinto General Hospital (Meditech)
• 5 Keys to Choosing the Best Rehab Therapy EMR Solution (Net Health)
• Industry Insights: Mandi Wasik, Availity’s Data Connectivity Program Manager, on Clinical Data Aggregation, Quality Improvement, and DAV Certification (Availity)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 11/30/23

We’ve made it past some of the early fall holidays, and those of us on the front lines are waiting to see if they will cause a spike in respiratory illnesses.

Heading into Thanksgiving, many parts of the US were feeling the pressure already. Respiratory Syncytial Virus (RSV), COVID, and influenza are leading the pack. At one point, all of the pediatric hospital beds in the Dallas-Fort Worth area were full, which should ring alarm bells for those who care about children.

My colleagues at Cook Children’s in Fort Worth mentioned that they were seeing up to 500 patients daily in the emergency department and were boarding critically ill patients in the emergency department because there were no ICU beds. New vaccines for RSV are in short supply in some regions, which will likely add to the problem later in the season.

This week, I ran across a couple of articles that talked about the fact that ChatGPT has only been around for a year or so. Headlines included phrases such as “ChatGPT scared the heck out of us,” and there was a lot of retrospective thought about whether its launch opened as big of a Pandora’s box as everyone thought it might.

Generative AI has certainly matured over the last year. There’s still a lot of hype about how it’s going to transform the way people work. One suggested that managers use AI to help define ambitious deadlines for projects that are underway, or that they can use it to create motivating speeches for their teams. It went on to say that AI could help identify ways to make the workplace more exciting.

Another gave the idea that AI could be used to create employee satisfaction surveys and to process results to determine how employees want to be incentivized. I kind of like this one since I’ve worked for several employers that totally disregarded employee sentiments. Maybe because AI is such a darling, they’ll pay attention to those results just because they were processed using a tool versus a basic employee survey. One article brought up an interesting tidbit about OpenAI’s GPT-4, namely that certain restrictions can be bypassed by using less-common languages such as Gaelic or Zulu. That’s definitely interesting, and you can bet I’ll be playing around with that idea.

Just a few days prior to the Veterans Day holiday in the US, the Department of Veterans Affairs (VA) met its goal of enrolling one million veterans in its genetic database, aptly named the Million Veteran Program. The database is unique because it links genetic information with electronic health records and also includes information on diet and environmental exposures. Researchers have been working for 12 years to reach the goal. Compared to other genetic databases in Europe, this one represents a more diverse population. The data is only available to physicians and scientists at VA facilities. Veterans can continue to enroll either through the link above or by calling 866.441.6075 to make an appointment at a VA facility.

Although the VA’s EHR project certainly gets a lot of press, there is so much more that the organization is doing to support veterans. It’s a vast organization, with locations from coast to coast. This year, the Veterans Health Administration delivered 116 million patient appointments at 1,300 facilities, beating the previous record by 3 million. It’s not only a care provider, but manages benefits applications and compensation programs, which necessitates maintaining a different staffing profile than other healthcare organizations. It’s also responsible for delivering services around those parts of its business. To give you an idea of scale, its Health and Benefits App reached 1 million downloads this year.

The VA is also actively investing in the artificial intelligence space, working on tools to reduce employee burnout. It plans to launch an AI-related contest that features $1 million in prize money for teams that create the best solutions in speech-to-text for medical appointments and in document processing as non-VA medical records are added to the patient’s VA chart.

Several of the physician groups that I follow on Facebook have had an overwhelming number of posts about cybersecurity incidents. Since organizations tend to take their entire network down when there is an incident, that means that physicians have no access to downtime solutions such as disaster recovery servers or third-party information archives. Although the health systems in question typically put out press releases that state that patient care is being delivered safely and effectively, comments from the trenches seem to reflect an environment that is anything but:

• No ability to look up labs.
• No way to access history and physical forms for surgical procedures.
• Hand writing operative reports.
• Clinicians who are relatively new grads have never charted on paper.
• Systems haven’t practiced for downtime events, resulting in mass chaos.

One clinician whose system recently went through a cybersecurity event but is back online noted that she recommends keeping copies of all handwritten notes. Apparently, many were lost during the event and were not scanned or otherwise added to the system, resulting in requests for her to redo documentation weeks after the event. Another reported that his hospital was down for over a month, which as a clinician, I can’t even imagine. Hackers are a reality and organizations that think it couldn’t happen to them are mistaken. I challenge all the CIOs and CMIOs out there to ensure their organizations have adequate supports in place and that they’re practicing for a potential event.

I dropped by my primary care office this week to get a vaccine booster. Despite having just had my photo ID scanned at another office in the same system last week, I had to again present photo ID to be scanned as opposed to just being verified. I could see the previous scan of my photo ID on the receptionist’s screen, since there was no privacy filter on the monitor. I could also see my photo on my patient chart, which matched the already-scanned ID. I understand she was likely just following an office policy, but this is where I challenge people to make sure that the policies in place make sense and/or provide value or whether they’re just process for process sake.

I was also greeted with a 2020-esque COVID interrogation, including being asked if I had traveled internationally in the last six months (yes), whether I had been around sick people (yes), whether I had traveled internationally in the last 30 days (yes), and whether I had any respiratory symptoms (no). There were no follow-up questions to any of the positive responses.

As I sat waiting to be called back, another couple came in, and when asked the question about sick people, they asked, “What do you mean by sick?” It was clarified to be “measles, mumps, or chicken pox.” I suppose I should have been a “no” on that one then. They weren’t asked the question about symptoms. The couple was already wearing medical masks, so I’m guessing the receptionist made an assumption if the intent of the questioning was to determine if patients should have masks. Respiratory season is upon us and it will be interesting to see if the questionnaires morph as the season progresses.

The good thing that came out of that visit is that they pointed out that I had an open order for follow-up testing, which was interesting because the test had been allegedly scheduled during the in-person visit at another office last week. Apparently it hadn’t been scheduled properly, and had I not gone for that vaccine, I wouldn’t have had a clue. Four phone calls later, I finally had it scheduled, and I must say the patient experience component of the entire process has been lacking. At no point during any of the conversations did anyone apologize for the dropped ball, not even a lukewarm “I’m sorry you’re feeling frustrated by this.” It’s not an experience I want for my patients either, which is making me rethink my referral patterns. Where’s a patient satisfaction survey when you need one?

Does your organization actively work to stamp out non-value-added processes, or is it content with simply doing things the way they’ve always been done? Have they shifted processes to put more of the burden on the patient? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/30/23

Tampa General and Synapse Florida Seek Innovation Solutions to Reduce Cancer Mortality in Rural Communities

Tampa General Hospital, its Innoventures venture capital arm, and Synapse Florida launch a $50,000 innovation challenge to discover solutions that may improve cancer care in rural areas.

Mayo Clinic unveils plans for a new $5 billion campus in downtown Rochester

Mayo Clinic will redesign its campus in Rochester, MN to create health neighborhoods where patient care is more streamlined through remote patient monitoring, AI, and automation.

Honoring Excellence: CHIME Recognizes Outstanding Achievements of Digital Health Leaders and Professional Services Firms with the 2023 CHIME Awards

CHIME names Tufts Medicine EVP, Chief Digital Officer, and System CIO Shafiq Rab its 2024 CIO of the Year.

Healthcare AI News 11/29/23

News

Amazon announces Amazon Q, a generative AI assistant for businesses that provides personalized company content to employees.

NHS England will use AI to identify patients who are at risk for an ED visit or hospital admission and could instead be contacted by health coaches, including the use of sensors on refrigerators and teakettles to identify changes in eating and drinking habits. It is also using AI to predict the  top at-risk patients who are then contacted by staff who offer social care assessments and medication reviews. NHS has also expanded its hospital-at-home program to 10,000 patients. It expects the new programs to prevent 4,500 ED visits, 17,000 overnight hospital stays, and 23,000 physician appointments.

Hong Kong’s hospital authority will pilot the use of AI to identify potentially inappropriate ordering of certain broad spectrum antibiotics following a jump in vancomycin-resistant infections. Broad-spectrum antibiotic prescribing jumped during the pandemic as COVID-19 patients used most available isolation beds. 

A Denver news outlet describes the efforts of UCHealth to apply AI to sepsis detection. CMIO C.T. Lin, MD says its initial deployment of Epic’s tool was causing alarm fatigue and a flurry of end-of-shift alerts as overworked nurses back-entered vital signs they had scrawled on their arms all day. The health system redirected the alerts to its virtual health center, where 24/7 ICU nurses monitor the vital signs of up to 500 patients and can immediately review the EHR and live video feeds. UC Health estimates that the sepsis alerts are saving 375 lives per year, with another 800 patients saved by early detection of other forms of deterioration.

Business

Drug maker Roche’s Genentech subsidiary will collaborate with microprocessor vendor Nvidia to advance drug discovery.

Vivodyne, which uses AI-powered robotics to cultivate, dose, and analyze prospective drugs on human tissues, raises $38 million in seed funding.

Research

Researchers use AI to identify brain imaging markers that may help diagnose ADHD in adolescents.

A Microsoft study finds that GPT-4’s performance on medical specialty questions can be improved by the use of more carefully structured prompt alone, without being expensively trained on more detailed data.

Republic of Korea researchers develop a machine learning model to predict cardiac arrest in ICU patients using ECG data, which they say is a better predictor than EHR information and can be used for continuous monitoring. 

Other

Sports Illustrated gets caught running AI-generated articles that are bylined to AI-generated writers with headshots that were acquired from online marketplaces. One article purportedly written by “Drew Ortiz” expertly opines that “volleyball can be a little tricky to get into, especially without an actual ball to practice with.”

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Morning Headlines 11/29/23

Here is why IT major TCS has to pay $210 mn to rival firm DXC

Tata Consultancy Services, which was just assessed with $140 million in punitive damages for stealing Epic’s intellectual property by having its employees pretend to be hospital consultants, is hit with a similar $210 million judgment involving insurance software.

Aidoc Unveils $30M Investment in Revolutionary Foundation Model for Imaging AI at RSNA 2023

Medical imaging AI vendor Aidoc will use $30 million in recently announced funding to develop an imaging AI foundation model.

Harmony Healthcare IT Partners with Novacap to Accelerate Innovation and Growth in Healthcare Data Management

Health data management company Harmony Healthcare IT secures an undisclosed amount of funding from Canadian investment firm Novacap.

PayGround Announces $19.7M Oversubscribed Series A Funding Round

Patient payment app startup PayGround raises $19.7 million in a Series A funding round, enabling it to expand beyond its ambulatory roots into more inpatient settings.