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.”

Contacts

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

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.

News 11/29/23

Top News

Ardent Health Services works to recover from a November 23 ransomware attack that forced it to take its computer systems offline across its six-state network of 36 facilities.

The health system specifically mentions in its latest data security update that it is working to restore access to Epic.

Numerous of its providers resorted to ED diversions and postponing surgeries and appointments.

Reader Comments

From Drupal: “Re: community hospitals that offer oncology and don’t use Epic or Cerner. I am looking to speak to a hospital contact who understands the market opportunity for chemotherapy ordering, medication preparation, and patient-reported outcomes. Can you offer advice or contacts?” I’ll ask readers who have ideas to contact me and I’ll connect you.

From Reese Peace: “Re: AI. It seems that use cases have polarized to the complex and theoretical on one end and and the rather dull effectiveness boosters on the other.” I expect initial AI successes to focus on that latter category, where solutions could be developed that are inexpensive, non-threatening to clinicians, free of FDA oversight, and non-intrusive to patients. Examples:

• Journal article search, although that will be limited by the paywalls of for-profit journals that will expect to be paid for allow their content – which was provided free by authors, many of them working under taxpayer grants – to be used for AI training and then for user access.
• EHR search, including PDFs and free text. This is simple and already being done to unknown extent.
• Creating patient-facing documents, including those specifically create clinician dictation and then formatted and optimized for patient-level reading.
• Pre-visit triage and summarization. In-person visits could be prefaced, as with telehealth, by a pre-visit chatbot interview or data collection to avoid wasting encounter time.
• Encounter transcription and data extraction, as with ambient clinical documentation.
• Continuous monitoring of data from wearables and remote patient monitoring.
• Streamline insurer prior authorization and initial claim validation.
• Monitoring during surgery with visual and audio alerts or responses to questions.
• AI-powered robotics for manual tasks.
• Improving and personalizing available clinical decision support.
• Inbox management, which is clearly the frontrunner for AI value in healthcare.
• Guide non-physicians through patient encounters via protocols and guidance under some level of supervision.
• Predict workload, staffing needs, patients who are likely to miss appointments, and scheduling preferences.

HIStalk Announcements and Requests

I added a previously unnoticed sort-by-date option to the HIStalk search function, which is powered by Google Site Search and is listed as a link at the top of the page. I’ll definitely use this.

Bitdefender offered me a one-year renewal for my soon-expiring five-device Total Security for $50, after which a quick Google search led me to find a two-year renewal on Best Buy for $31. You can buy a renewal at any time, and paste the key code into Bitdefender Central, where it tacks the additional years onto your expiration date.

Reader Mark once again celebrated the holidays with a generous donation to my Donors Choose teacher grant project, which I then boosted with GivingTuesday matching funds as well as those from my Anonymous Vendor Executive to fully and anonymously fund these STEM-related projects:

• Noise-cancelling headphones for Ms. D’s middle school science academy class in Youngstown, OH.
• Math games for Ms. O’s elementary school class in Rosharon, TX.
• Math manipulatives for Ms. R’s elementary school class in Redford, MI.
• Hydroponic gardening kits for Mr. K’s high school class in Burton, MI.
• STEM manipulatives for Ms. I’s elementary school class in Far Rockaway, NY.
• Gardening kits for Mr. H’s elementary school class in Paterson, NJ.
• STEM activity kits for Ms. A’s elementary school class in Savannah, GA.
• Math puzzles for Mx. R’s middle school class in Saint Cloud, MN.
• Geometry review books for Mr. H’s high school class in Bronx, NY.
• A laptop speaker for Ms. G’s elementary school class in San Lorenzo, CA.
• Math manipulatives for Ms. R’s elementary school class in Magna, UT

Webinars

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

Acquisitions, Funding, Business, and Stock

India-based 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. The lawsuit alleges that a TCS employee copied a competing firm’s source code and documentation and sent it to colleagues who were struggling to figure out how to perform an insurance calculation.

Bloomberg says that Amazon has failed to disrupt healthcare while over-promising and under-delivering. Current and former employees say the company is overconfident that it can beat healthcare incumbents without hiring healthcare expertise or listening to experts, adding that its recently announced One Medical discount for Prime members isn’t much of a development.

Sales

• Baptist Memorial Health Care (TN) chooses Optimum Healthcare IT to lead its EHR implementation on Amazon Web Services.

People

PointClickCare Technologies promotes Travis Palmquist to SVP/GM of emerging markets.

Sondra Hornsey, MS (Stanford Health Care) joins Vanderbilt University Medical Center (TN) as chief privacy officer.

Hearst promotes Carolyn Simpkins, MD, PhD to president of its Zynx Health business.

Shally Pannikode, MBA (Liberty Mutual) joins Zelis Health as CTO.

Erica Drazen, MS, ScD — who retired in 2013 after a 40+ year health IT career that included roles at Arthur D. Little, First Consulting Group, and CSC — died November 25. She was 77. 

Announcements and Implementations

Klickitat Valley Health (WA) launches virtual consult technology from Eagle Telemedicine to support its ED, hospitalists, and nurses.

Nym makes its autonomous medical coding technology available to inpatient facilities.

Glacial Ridge Health System will go live on Meditech Expanse this week.

Amazon Web Services announces Amazon Q, a generative AI assistant for businesses.

Other

A technology conference is exposed for using AI to create fictitious female speakers to create the illusion of gender diversity and attract presenters who decline events with all-male lineups. The for-profit DevTernity conference brags that it selects speakers using the “Hollywood Principle” in which it replaces calls for papers with “don’t call us, we’ll call you.” The conference organizer says it was too hard to get women speakers for the $870 online conference and the phony bios were just a placeholder. The conference was cancelled after speakers and sponsors pulled out. The conference organizer is also suspected of creating a fake female tech Instagram influencer who mostly showed skin as she pitched the conference.

A South Dakota hunting lodge operator is gored by a bison and is evaluated and treated in the ambulance from an ED doctor who was 140 miles away. Jim Lutter, 67, was picked by a ambulance squad volunteer, who left his hardware store job to respond to the 911 call and used the state-funded ambulance telehealth system to get ED physician instructions and then alert the hospital that they were coming.

Sponsor Updates

• EClinicalWorks publishes a new customer success story, “Transforming Care with RPM Seamless Integration.”
• Sydney Adventist Hospital in Australia enhances its MRI appointment utilization and patient care through Foxo and Agfa HealthCare’s enterprise imaging platform.
• Dimensional Insight announces that it has been recognized as the top outsourced analytics solution in Black Book Market Research’s annual outsourcing services survey.
• Trillium Health Partners in Canada adds AI-as-a-Service capabilities from Sectra to its Sectra enterprise imaging technology.
• SouthLake Regional Health Centre clinicians in Ontario reduce time spent on medication reconciliation by 64% using DrFirst’s MedHx powered by SmartSuite technology, according to the results of a recent pilot study.

Blog Posts

• The Evolution of Patient Access: A Look at the Modern Landscape (Vyne Medical)
• Future-forward healthcare: Data platform considerations (Arcadia)
• Trusted Data Sharing and Collaboration for Health and Biomedical Research – Pick your acronym (Aridhia)
• Cameras and Computer Vision: Accurately Capturing Human Movement with Injury Prevention Tech (Bardavon)
• Beyond the Media Buy: Opening the Pandora’s Box of Point-of-Care Program Measurement (ConnectiveRx)
• Why Healthcare Organizations Should Pursue a Multi-Cloud Strategy (CloudWave)
• The Role of Data in Healthcare Performance Improvement (Dimensional Insight)
• The Evolution of Healthcare Technology Roles: A Guide for Hiring Managers (Direct Recruiters)
• AI, Analytics, and Burnout: CHIME 2023 Fall Forum Insights (Divurgent)
• Optimizing Medication Management Workflows in Your EHR (DrFirst)

Contacts

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

Morning Headlines 11/28/23

Ardent Health Services Reports Information Technology Security Incident

Ardent Health Services works to recover from a November 23 ransomware attack that forced it to take systems offline across its six-state network.

RepeatMD lands capital to grow its aesthetics and wellness booking business

Patient acquisition and retention software startup RepeatMD raises $40 million, bringing its total raised to $56 million.

Wyden, Merkley: USDA Invests $2.28 Million to Expand Health Care and Broadband Assistance in Rural Oregon

Senators Ron Wyden (D-OR) and Jeff Merkley (D-OR) will distribute a grant of $2.28 million to providers in five Oregon counties so that they can provide more virtual care.

Curbside Consult with Dr. Jayne 11/27/23

We’ve made it past the Thanksgiving holiday, and hopefully people were able to spend time with their loved ones and then have a little time on their own to de-stress before heading back to work.

Historically, this time of year brings out all kinds of family drama. Looking at the data from one of the practices I work with, over the past couple of years there have been upticks in the number of visits for anxiety and depression between mid-November and mid-January.

Although I avoided dinner time conversations about Medicare, one family gathering involved a conversation about hospital-affiliated primary care practices that are charging facility fees. Another covered the move of private equity organizations into the local care ecosystem, leading to decreased access as they cut providers from their rosters following acquisition. US healthcare is certainly in a dark spot, and patients are paying the price as they find it more difficult and more expensive to get the care they need.

Local pharmacies have been eager to step into this gap. However, one elderly relative discovered that it wasn’t as easy to get appropriate care as it should have been. She’s in her 80s and has multiple risk factors for severe disease from RSV infection, so she tried to make an appointment for the recently approved vaccine. She walked into a location of a nationwide retail pharmacy chain and was told she couldn’t get the vaccine without an appointment. However, per her recollection of the story, they wouldn’t make an appointment for her, instead telling her to call for one. She called and wound up in a phone tree system, which kept prompting her to choose a location despite the fact that she was standing in one. When she selected the prompt to speak to a representative, it continued to ring, but no one answered.

She went to another location, which refused to administer the vaccine because she didn’t have a prescription. I’m not sure if this was because the pharmacy didn’t have the appropriate standing order in place from their medical director, or if it was some kind of insurance issue, or if they didn’t want to do the counseling since the vaccine isn’t strictly recommended based on age but rather as a part of a shared clinical decision-making process.

Either way, she left without her vaccine and instead spoke to her primary care physician. It sounds like the primary physician isn’t keeping up with the literature, because he told her she didn’t need the vaccine because she “isn’t around babies,” which has nothing to do with the indications for the vaccine. It’s designed to reduce the burden for a disease that hospitalizes more than 60,000 older adults each year and results in up to 10,000 deaths among retirement-age adults each year.

I’m hoping that the EHR team at her primary care physician’s office ensures that the vaccine is added to health maintenance dashboards so that physicians who aren’t keeping current might be prompted to address the condition with their patients. Hopefully that hospital-affiliated organization will also be providing continuing education to ensure physicians are aware of current recommendations, since it’s foolish to assume that technology alone can solve a clinician knowledge gap.

But in the mean time, thinking about my family members, I was tempted to dig out a prescription pad and just write the order myself. I don’t practice medicine like that, though, so I provided some coaching to hopefully help the patient have a better conversation with her physician. In the mean time, I’ll be calling a couple of pharmacies to see if they have standing orders in place that would allow her to get the vaccine.

Is this a place where telehealth-only organizations might help patients that can’t get what they need? Probably not, since many of them won’t allow their clinicians to order injectable medications even if they are low risk, like vaccinations. At one telehealth organization where I worked during the height of the COVID pandemic, we weren’t even allowed to write letters that would have explained that patients were high risk and could receive priority vaccinations. Even though providers on those networks are usually independent contractors, they’re often constrained by group policies that prevent them from doing things that might otherwise be straightforward in a traditional medical practice.

Speaking of telehealth, a recent article in JAMA Network Open looked at how patients complete tests and referrals when those services are ordered as part of a telehealth visit compared to those ordered during in-person visits. The telehealth visits were delivered by providers at a large hospital-affiliated primary care practice and community health center in Boston during the time period between March 1, 2020 and December 31, 2021. The authors looked at colonoscopy orders, dermatology referrals for suspicious skin findings, and cardiac stress tests. They found that only 43% of orders placed during a telehealth visit were likely to be completed, compared to 58% of orders placed during in-person visits. Interestingly, 57% percent of orders placed without a visit (perhaps as a result of a non-visit telephone call, or a patient portal message) were completed.

The authors suspect that one reason for the discrepancy might be the absence of schedulers or medical assistants to help patients during telehealth visits, or the lack of follow up communications encouraging patients to close the loop on their orders. That doesn’t explain why the non-visit orders were completed as frequently as they were, however, unless schedulers were assisting those patients. I would be curious to look at completion rates for orders from third-party telehealth organizations. Some of them won’t even generate orders for patients because they have no way to get those orders to a performing facility near the patient. Others limit their orders to those that can be done as part of an employer wellness program, such as diabetes screening tests or cholesterol testing. Third parties are often worried about liability, and given the transactional nature of many visits, there isn’t a mechanism to follow up on abnormal test results or to easily communicate follow up instructions to patients.

As someone who has done a lot of process engineering work, these are the “people” and “process” parts of the equation, but I continue to see organizations that try to solve them with “technology” alone. I’d love to see more organizations put their money towards solving people and process problems, whether it’s integrating a checkout person or scheduler into a telehealth workflow or making it easier for patients to self-schedule certain tests and procedures or doing a better job of reminding patients of orders that aren’t completed. Certainly, technology is part of all of those solutions, but it’s not the only answer.

How is your organization making it easier for engaged patients to receive the services they need? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/27/23

DOD’s EHR Deployment Nearly Complete

The Department of Defense completes the last of 23 MHS Genesis go-live waves.

BSA diverting ER patients after ‘potential security incident’ causes network outage

BSA Health System (TX) reverts to downtime procedures including ER diversion due to a Thanksgiving Day network outage.

Hackers accessed sensitive health data of more than 8 million Welltok patients

A notice filed by Virgin Pulse-owned Welltok says the personal information of 8.5 million people was exposed in a breach of its Moveit file transfer system, with affected customers including BCBS plans, Sutter Health, Stanford Health Care, and The Guthrie Clinic.

HHS’ Office for Civil Rights Settles HIPAA Investigation of St. Joseph’s Medical Center for Disclosure of Patients’ Protected Health Information to a News Reporter

Saint Joseph’s Medical Center (NY) pays $80,000 to settle HHS OCR charges that it provided photos and information of three patients in April 2020 to the Associated Press, which was writing an COVID-19 story, without the approval of the patients.

Monday Morning Update 11/27/23

Top News

The Department of Defense completes the last of 23 MHS Genesis go-live waves.

The military’s final Oracle Health implementation is scheduled for March 2024 at Lovell Federal Health Care Center, which it jointly operates with the VA.

DoD says that its teams are anxious to move on to optimization and applying analytics at the site and enterprise levels.

HIStalk Announcements and Requests

Poll respondents aren’t optimistic that any of the usual suspects can disrupt healthcare, but they choose retailers as the best hope. I’m intrigued that they chose employers as the least likely given that they are footing much of the bill and have the only significant amount of clout, which they never seem to use.

New poll to your right or here: What is your single biggest frustration with your primary care provider? I’m allowing only one answer to hide the noise of problems that aren’t the main one.

Webinars

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

Acquisitions, Funding, Business, and Stock

London-based Phare Health, which offers medical coding tools, raises $3.1 million in a seed funding round.

Sales

• Memorial Hermann Health System will implement Laudio’s worklfow automation tool for frontline leaders and has invested in the company.

Announcements and Implementations

Researchers develop a wireless acousto-mechanical system whose wearable sensors continuously transmit data about body movement sounds such as breathing, digestion, and cardiac activity.

London-based digital-first home healthcare provider Cera says it will provide 5 million care visits this winter to help address hospital capacity problems. Founder and CEO Ben Maruthappu, BM BCh. MPH was trained at London School of Hygeine and Tropical Medicine, University of Cambridge, Harvard, and University of Oxford.

A health official in China touts the country’s digital health success, listing online diagnosis and treatment, prescription services, fever clinic information, and hospital wait time.

A16z lists the jobs that AI could perform to reduce provider burnout and increase effectiveness, which it says should be supported by CMS in the form of increased payment for AI-assisted or augmented care (click the image to enlarge).

Privacy and Security

Saint Joseph’s Medical Center (NY) pays $80,000 to settle HHS OCR charges that it provided photos and information of three patients in April 2020 to the Associated Press for a COVID-19 story without their approval.

A notice filed by Virgin Pulse-owned Welltok says that the personal information of 8.5 million people was exposed in a breach of its Moveit file transfer system. Affected customers include BCBS plans, Sutter Health, Stanford Health Care, and The Guthrie Clinic. Virgin Pulse acquired the company in November 2021.

Other

Politico notes that a physician shortage will force the federal government to stitch together a primary care system that is delivered by nurses, physician assistants, and virtual visits, with no promise that people can get, much less keep, a regular doctor. Long appointment waits are sending sick people to the ED, urgent care, or pharmacy-located clinic where services are purely transactional with no promise of prevention or taking the patient’s personal or even medical history into account.

Cigna creates public outcry when it denies transplant coverage to a 47-year-old woman who was being prepped for a double lung transplant after being rushed to Vanderbilt University Medical Center when a matching donor had been found. VUMC sent her home and took her off the transplant waitlist. Cigna had previously approved the procedure, but found that the woman had the unapproved condition of terminal cancer. As is often the case, the insurer paid more attention to the bad press than to the patient and doctors in reversing its decision that it declared to have been an “error.” The patient now requires additional tests, the donor lungs are no longer available, and her only hope is to be placed back on the waitlist. Cigna got the black eye, while VUMC has drawn no public ire for declining to perform the transplant in the absence of Cigna’s willingness to pay.

Sponsor Updates

• Health Data Movers appoints Curtis Cole, MD (Cornell University) to its board.
• Through partnerships with Redox and Xealth, Tidepool develops EHR integrations for its diabetes data visualization software.
• Five9 will present at the UBS Global Technology Conference November 29 in Phoenix and the Barclays Global Technology Conference December 7 in San Francisco.
• Fortified Health Security names Kameron McNicholas senior SOC engineer.
• Health Data Movers names Curtis Cole (Cornell University) to its Board of Directors.
• Healthcare IT Leaders releases a new Leader to Leader Podcast, “Leading Through Growth and Change.”
• Inovalon develops Converged Analytics Benchmarking to provide health plans with monthly determinations of their relevant national and state benchmarking for quality measurement and improvement initiatives.
• InterSystems launches its HealthShare Health Connect Cloud solution in New Zealand.
• A recently published study on brain health, “Using digital assessment technology to detect neuropsychological problems in primary care settings,” features Linus Health’s Core Cognitive Evaluation digital assessment technology.
• Nordic names Claire Staple VP of strategy and country manager in Ireland.

Blog Posts

• ECW – Your AI-powered EHR (EClinicalWorks)
• Tech-Enabled Health Equity: Bridging Language Barriers in Health Education (Healthwise)
• Prevention is Key: How AI-driven Early Detection Can Enhance Population Health Outcomes (Lucem Health)
• The Hidden Recipe for Successful EHR Implementation (Medhost)
• Expanse Genomics: How we’re extending our industry-leading solution (Meditech)
• New Policy Changing the Mental Health Landscape: Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (NeuroFlow)
• How NTT Data & Carpl.ai are revolutionizing medical imaging (NTT Data)
• DSN: Healing the Healthcare System (OmniSys)
• How Patient Journey Mapping Improves the Patient Experience (PerfectServe)
• Optimizing Workflows: 8 Benefits for Faster and Easier Credentialing (QGenda)
• California says goodbye to fax machines. Hello to DxF. (Redox)
• 6 Reasons Your Risk Reporting System is Failing You (Symplr)

Contacts

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

Morning Headlines 11/23/23

Tri-City Medical Center resumes nearly full operations after cybersecurity attack

Tri-City Medical Center (CA) resumes normal operations after a ransomware attack November 9 forced it to downtime procedures.

Company operating Nacogdoches Memorial Hospital files for bankruptcy

In Texas, Nacogdoches Memorial Hospital operating company Lion Star files for bankruptcy with debts of $10 million to $50 million owed to between 200 and 1,000 vendors, including $1 million owed to an EHR vendor.

Queensland Health fixes ieMR system crash after staff unable to login for hours

Queensland Health resolves an EHR log-in issue that had prevented users at its 24 facilities from accessing the Oracle Health system for several hours.

Morning Headlines 11/22/23

Patient privacy fears as US spy tech firm Palantir wins £330m NHS contract

NHS England awards a consortium that includes Palantir and Accenture a five-year, $415 million contract to develop and operate the Federated Data Platform data-sharing platform across NHS trusts and care sites.

TCS Q3 to take $125 million hit on Epic Systems Corporation legal woes

Tata Consultancy Services will pay $140 million in punitive damages to Epic related to a 2014 case in which Epic accused TCS of downloading confidential material from UserWeb by having its employees pretend to be Epic customer consultants.

McWilliams School of Biomedical Informatics researchers awarded $31M in grants for medical artificial intelligence innovation research

Fifteen faculty members of UTHealth’s bioinformatics school are awarded $31 million in grants, $19 million of which came from NIH’s National Institute on Aging.

News 11/22/23

Top News

NHS England awards a consortium that includes Palantir and Accenture a five-year, $415 million contract to develop and operate the Federated Data Platform data-sharing platform across NHS trusts and care sites.

Medical groups and other watchdogs immediately expressed concern that a US firm that is best known for providing military and espionage software to the CIA and foreign governments will be handling sensitive patient information. They also noted that founder and chair Peter Thiel in on record as declaring that NHS “makes people sick” and should be privatized. He has also stated that NHS support by Britons is a form of “Stockholm syndrome.”

The contract, which follows extensive government lobbying by Palantir, does not include Scotland or Wales.

PLTR shares dropped on the news, valuing the company at $43 billion.

Reader Comments

From Ossifier: “Re: Forward Health’s CarePods. Maybe when they fail in the US and the company pivots once again, they can offload their unused pods to the French government.” France’s national railway will install appointment-only Loxamed telemedicine setups in 300 train stations that are located in medical deserts by 2028, which will feature on-site nurses who use connected medical equipment and sessions with virtual physicians, with services are billed to the national social security system. France’s physician union has objected strongly to the plan, saying that “There can be no good medicine that comes from the touch of a button, at a distance, from a doctor who does not know the patient.” Loxamed was formed in March 2020 by an equipment rental company to offer COVID-19 diagnosis and eventually vaccination. My take is that people could initiate their own telemedicine visits from home, so the advantage of this plan is the ability to be evaluated by an in-person nurse who can take vital signs and perform assessment before the remote physician takes over.

Webinars

December 7 (Thursday) 2 ET. “Waystar + Epic Workflow 101: How to Maximize your Epic Investment.” Sponsor: Waystar. Presenters: Christine Fontaine, solution strategist, Waystar; Lori Anderson, channel partner director, Waystar; Ashley Rose, associate director of client consulting, Waystar. Many users are curious about enhancing their Epic environments, but how do you know which features your organization needs? During this session, you will be provided a proven process to help you evaluate Epic-related decisions, tangible examples of need versus want criteria, and concrete steps to extract full value from Epic workflows and environment.

Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.

Acquisitions, Funding, Business, and Stock

AstraZeneca launches Evinova, a separate business that will further scale digital health solutions that are already used by the pharmaceutical company; and develop and market digital products in the areas of clinical trials, remote patient monitoring, and therapeutics.

UpHealth will sell Cloudbreak Health and its Martti telehealth language interpretation services to private equity firm GTCR for $180 million. UpHealth is in the process of selling off or winding down certain service lines, with its focus now on its behavioral health business in Florida. Several UpHealth subsidiaries filed for Chapter 11 bankruptcy protection in September.

Novant Health (NC) will buy three South Carolina-based hospitals from Tenet Healthcare in a $2.4 billion deal that includes RCM services from Tenet subsidiary Conifer Health Solutions.

App-based chronic care company Vida Health raises $28.5 million, bringing its total raised to $216 million.

Clinical notes analysis startup Layer Health raises $4 million in seed funding. Its debut product, Distill, helps clinicians find and submit data to clinical registries. The company’s five co-founders all have MIT-related backgrounds in AI, machine learning, and computer science.

Likely sensing a vacuum since the departure of Cerner for greener Oracle pastures, non-profit Digital Health KC hopes to help launch or lure 20 digital health companies to the Kansas City area using $4 million in grants.

Sales

• NYU Langone signs a $115 million contract with Philips for enterprise informatics, pathology, AI-powered diagnostic imaging, and patient information technologies; as well as its Capsule Medical Device Information Platform.
• Oregon Health & Science University will implement Visage Imaging’s Visage 7 enterprise imaging software.
• McAlester Regional Health Center (OK) selects Smart Analytics from Sixth Sense Intelligence.
• Children’s National Hospital in Washington, DC will use IT infrastructure services and technology from Kyndryl.
• The Florida Department of Children and Families will implement Juno Health’s behavioral health EHR at Florida State Hospital.
• Teladoc Health will open a virtual ED in a rural, remote part of Canada’s Newfoundland Labrador Health Services under a two-year, $16 million contract in which the patient will first see an in-person clinician, then be diagnosed and treated virtually.

People

Joe Murad (WithMe Health) joins Vida Health as CEO.

Announcements and Implementations

Washington County Hospital and Clinics in Iowa goes live on Epic.

Fifteen faculty members of UTHealth’s bioinformatics school are awarded $31 million in grants. $19 million of which came from NIH’s National Institute on Aging.

Lincata launches an in-room hospital entertainment system that features patient engagement and health system marketing opportunities. The company’s executive board chair is industry long-timer Tom White, MBA, who is best known as co-founder and CEO of Phynd until the company was acquired by Symplr.

Government and Politics

Tata Consultancy Services will pay $140 million in punitive damages to Epic related to a 2014 case in which Epic accused TCS of downloading confidential material from UserWeb by having its employees pretend to be Epic customer consultants. The original award of $940 million has been reduced several times in court reviews. The US Supreme Court rejected TCS’s appeal of punitive damages on Monday, where the company argued that it had already paid $140 million in compensatory damages from the original award.

HHS OIG warns consumers that scammers are cold calling Medicare enrollees to obtain their Medicare ID, after which they are signed them up for phony remote patient monitoring services that are billed monthly from pharmacies or durable medical equipment companies.

Other

The South Eastern Health and Social Care Trust in Northern Ireland celebrates the birth of the first baby born with an Encompass digital health record. The trust went live on Epic November 9. The system will be rolled out to remaining trusts over the next 18 to 24 months.

An AvaSure study of virtual patient sitting technology versus in-person sitting at Providence finds that virtual sitting is correlated to lower levels of burnout.

KFF’s Bill of the Month involves a woman’s first prenatal checkup, during which the nurse suggested having the standard panel of blood tests drawn at an office down the hall for convenience. The office belongs to a hospital that is run by religious non-profits Texas Health Resources and AdventHealth, whose lab billed her insurance at hospital rates for $9,500. Anthem BCBS negotiated the price to $6,700 and paid $4,300, leaving the patient to owe $2,400 for standard blood chemistry and STI tests. The average price of a CBC in Texas is $6 in an independent lab and $58 in a hospital, while the hospital in this case billed her insurance $207. She spent 10 months trying to ask questions, during which the hospital sent her bill to collections and ignored complaints that she had filed with the state’s attorney general. The hospital responded only when KFF started asking questions for its story, after which it cancelled all charges that, as it turn out, had been incorrectly submitted as diagnostic rather than preventive, which BCBS would have covered even at the inflated prices. Experts contacted by KFF questioned how well insurers negotiate hospital contract prices.

Sponsor Updates

• Baker Tilly publishes a new case study, “Healthcare organization tests technical security controls and internal security awareness training with phishing campaign.”
• Bamboo Health adds discharge summaries to its Pings real-time care notifications platform.
• Prisma Health integrates Artera’s patient communications platform with Gozio Health’s location-aware mobile engagement platform.  
• The Northern Virginia Technology Council recognizes DrFirst as a top technology company for the fourth year in a row.

Blog Posts

• How a Growth Mindset Can Drive Automation Success in Healthcare (Vyne Medical)
• The Journey to True Autonomous Coding (AGS Health)
• How the data lakehouse will revolutionize healthcare (Arcadia)

Contacts

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

Morning Headlines 11/21/23

Medmo Raises $9M in Funding

Medical imaging technology company Medmo, which matches patients with partner imaging centers, raises $9 million.

Reed Jobs’ Yosemite makes first digital health bet on Maia Oncology

Maia Oncology, a virtual primary care clinic for cancer patients, raises $4.25 million in seed funding.

AstraZeneca launches Evinova, a health-tech business to accelerate innovation across the life sciences sector, the delivery of clinical trials and better health outcomes

AstraZeneca’s new stand-alone Evinova business will develop and market digital products in the areas of clinical trials, remote patient monitoring, and digital therapeutics.

Curbside Consult with Dr. Jayne 11/20/23

The Centers for Disease Control and Prevention (CDC) has launched an initiative to tackle burnout in healthcare. The Impact Wellbeing initiative falls under the auspices of the National Institute for Occupational Safety and Health (NIOSH). According to the tagline on its website, it’s designed for “building a system where healthcare workers thrive.” It will provide “evidence-informed solutions” and resources to hospital leaders on avoiding burnout and promoting wellbeing for workers.

I was pleased to see that the website encourages hospitals to use materials from the Dr. Lorna Breen Heroes’ Foundation to address how hospitals can help staff address mental health needs without being penalized. Many hospitals and healthcare organizations still have questions on their employment and credentialing applications that stigmatize mental health conditions rather than supporting those that live with them.

As an example, one job for which I applied asked, “Have you ever been treated for a mental health condition?” with boxes to check yes or no, but no way to provide explanatory information. A better way to approach this is to ask whether the applicant has any current impairment that will prevent them from performing the duties of the position. There are plenty of mental health conditions that are episodic, and asking about past conditions that may be resolved hasn’t been shown to do anything but prevent people from honestly answering the questions.

In looking at some of the other materials on the site, as well as interviews with NIOSH staff that appeared in the media at the time of the announcement, it feels like the organization’s leadership understands that talking about resiliency or offering wellness programs doesn’t scratch the surface where employee mistreatment is concerned. Healthcare workers encounter bullying, harassment, and moral injury on a daily basis and those elements need to be addressed as part of an overall solution.

The initiative also encourages the leadership of healthcare delivery organizations to involve those affected in the process of defining the issues and solving them. I don’t know when it became a revolutionary idea to talk to people in order to understand their needs, but I’m happy to see recognition of the idea featuring prominently in the campaign. Organizers can use the NIOSH Worker Well-Bring Questionnaire to better understand where their workers are across domains that include policies, culture, environment, personal health, and home/community factors.

Although I appreciate that the focus of the campaign is on hospitals since they’re such a critical part of our healthcare infrastructure, I’d like to see these elements addressed in other care delivery sites, such as urgent care centers. There are 14,000 urgent care centers in the US, and according to data provided by the Urgent Care Association, more than 25% of adults visited an urgent care center in the last year.

Unfortunately, the level of regulation for those facilities varies from state to state, and in talking to physician colleagues, abuses are becoming more common as private equity companies expand in the industry. For a while, we saw a lot of emergency department physicians leave those environments to go to the relatively slower pace of urgent care. However, as the complexity of patients presenting to urgent care rises, and the number of patients physicians are expected to see each hour increases, we’re seeing physicians leave those environments as well.

Given the reliance by hospitals on nurses to deliver patient care, there’s a lot of push by nursing organizations to improve things. Since urgent cares use many more non-nurse caregivers — such as medical assistants, emergency medical technicians, and unlicensed patient care technicians — to deliver care at a lower cost, there aren’t many advocacy organizations looking out for those workers.

Quite a few urgent care centers are physician owned and operate more under a private practice model than an emergency care model, so that adds another element to the problem. In my area, a local multi-site urgent care center recently closed after the physician owner was arrested, leaving staff and patients in the lurch. Other organizations have struggled to absorb those visit volumes in the face of their own staffing shortages, and it’s been a bit of a mess.

Meanwhile, capable physicians sit on the sidelines because they’re not willing to go back to abusive environments. At my former clinical employer, nearly all the physician employees left when the private equity company that acquired it started tightening the screws to squeeze out more profit. I know at least six of us who would return from our early retirements if the working conditions were less atrocious.

In speaking with colleagues across the country, this experience is in no way unique. One local urgent care chain classifies its physicians as hourly employees, but pays a “shift rate” that requires them to stay until all patients have left without additional pay for the additional time. I’m not sure how that’s legal under state labor laws, but they’ve gotten away with it for a number of years. On the other hand, it might be one explanation for why they have locations that are mothballed because they can’t staff them.

I admit I didn’t read every single word on the CDC website for the program and didn’t follow every link, but I didn’t see any mention of how organizations need to do more to believe workers when they complain or how to take action when issues are reported. There is still a culture at many organizations of just saying “it is what it is” or “suck it up” when employees report exploitive practices. People are suffering from compassion fatigue, which can lead to lack of empathy and may contribute to workplace bullying if left unchecked.

At one local hospital, nurses scheduled for 12-hour overnight shifts routinely have to stay for 14 or 15 hours due to staffing issues. I guarantee that situation is not doing much for morale or burnout prevention. Even among healthcare workers, I hear comments like “you chose healthcare, what did you expect?” which doesn’t help solve the issue. I have a handful of non-medical friends who understand what we go through, but when medical folks can’t even support each other, how can we expect outsiders to understand what we’re going through?

It will be interesting to follow the progress of the initiative over time and to see how many organizations are using the tools and trying to drive positive change vs. just paying lip service to the idea.

If you’re a care delivery organization leader, had you heard of the initiative before today? What steps are you taking to drive change? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/20/23

Over 80 St. Louis NextGen Healthcare workers to be laid off

NextGen Healthcare files WARN documents indicating that it will lay off 84 employees in St.Louis in the first months of next year.

Novant Health to acquire three hospitals from Tenet Healthcare

Novant Health (NC) will acquire three South Carolina-based hospitals from Tenet Healthcare in a $2.4 billion deal that includes RCM services from Tenet subsidiary Conifer Health Solutions.

Aya Healthcare Acquires Winnow AI, a Data Science Driven Platform to Recruit Passive Physicians

Digital staffing platform vendor Aya Healthcare acquires Winnow AI, which identifies physicians who are open to new positions and relocation who match open roles.

GTCR to Acquire Cloudbreak Health

Private equity firm GTCR will acquire telehealth language interpretation services company Cloudbreak Health from UpHealth for $180 million.

Monday Morning Update 11/20/23

Top News

NextGen Healthcare files WARN documents indicating that it will lay off 84 employees it St.Louis in the first months of next year.

Meanwhile, executives who are cashing in on the November 10 sale of the company to private equity firm Thoma Bravo by selling shares include President and CEO David Sides ($15 million), CFO James Arnold ($12 million), and board member Srinivas Velamoor ($9 million).

Reader Comments

From AnInteropGuy: “Re: Veradigm. Continues to miss their filing deadlines and met with NASDAQ about the delisting situation — no news on how they will rule — but they have not been able to restate any of the questioned quarters. Leadership continues to say ‘very close’ but the remains substantially quiet on what the timeline looks like. Their last claim in September was that they would file by early November ahead of the NASDAQ meeting. That was before the announcement of the delisting notice so they had been made aware that they were facing delisting. They are still trying to gather contracts, payments, etc for the previous quarters and years — now apparently reaching all the way back to 2015.” A final SEC de-listing hearing was held on Thursday, but the decision hasn’t been announced. I don’t know the extent of accounting work that is required, but it seems strange that a publicly traded company whose shares are about to be de-listed can’t muster the resources, as other firms have done, to meet ASC 606 revenue recognition requirements. As a skeptic, I wonder if other motivations may be in play.

From Epson: “Re: Forward Health’s CarePod. I’m interested in predictions.” OK, here’s mine: (a) the company will deploy less than 250 devices versus its 3,200 goal; (b) issues with maintenance, limitations of the clinical model it was developed around, and lack of member loyalty will stall rollouts and raise questions about the viability of that business; and (c) Forward will try yet another pivot and the CarePods will move from malls to landfills given that no other company would have a use for them. I could be wrong, but Forward Health’s core business doesn’t seem to be sound enough to warrant gadgetary distraction, not to mention that as an N-of-one analysis I can’t see myself paying for such a service as described.

HIStalk Announcements and Requests

Poll respondents report seeing diminished influence across many of the newly established C-level technology roles within healthcare systems. What’s your experience with these positions being eliminated or downgraded? A LinkedIn wizard could probably find examples.

New poll to your right or here: Who is most likely to disrupt the US healthcare system to benefit patients?

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Also, for companies that have 2023 marketing funds to spend, we can bill you now and you can send your ad and materials later when you are ready. You get a full 365 days of sponsorship starting when your ad is posted. I’m mentioning this because Lorre has received the question several times this week.

Webinars

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

Acquisitions, Funding, Business, and Stock

Digital staffing platform vendor Aya Healthcare acquires Winnow AI, which identifies physicians who are open to new positions and relocation who match open roles.

Mass General Hospital and Brigham and Women’s announce that they cannot accept new primary care patients because their appointment waitlists are months long.

Children’s Hospital of Philadelphia, Stanford Health Care, and Children’s Medical Center of Dallas implement Wolters Kluwer’s Ovid Synthesis for evidence-based practice workflow applications.

Open AI’s board fires high-profile co-founder and CEO Sam Altman for unspecified reasons in a surprise announcement that wasn’t shared in advance with investors such as Microsoft, which owns 49% of the company. The rumored issue was product safety versus profit and Altman’s work to raise funds to create AI hardware companies outside of OpenAI’s non-profit oversight. Greg Brockman, co-founder, president, and board chair, was removed from the company’s board and then resigned. Several senior scientists also quit. The blowback has reportedly convinced the board to negotiate for Altman’s return, although he says he’s not that interested and would require significant governance changes to return. Meanwhile, the action that has likely cost Open AI much of its $80 billion valuation and the confidence of developers who use its products has also resulted in speculation that Altman and the other departed executives will immediately start a competing company, along with speculation that Microsoft should save OpenAI by buying the rest of it.

People

Lynsi Garvin, MSN, RN (Google Health) joins Intermountain Health as associate chief clinical information officer.

Adrienne Morrell (SCAN Health Plan) joins MRO Corp. as VP of governmental affairs.

Announcements and Implementations

Oracle will hold a one-day health summit on February 13 in Nashville, where the company is significantly expanding.

A new report from Center for Connected Medicine at UPMC finds that the patient engagement potential of health system-owned ambulatory pharmacies is being threatened by drug chains and technology firms that offer more convenient and innovative services and digital tools. Top operational challenges are 340B limitations and staffing issues, while the biggest consumer issue is lack of physical accessibility due to location, lack of transportation, and limited hours of operation. Top tools include delivery service and text-based refill reminders, while telepharmacy kiosks and self-pickup lockers have low interest.

Government and Politics

Memorial Hermann Health System and Texas Attorney General Ken Paxton settle the AG’s investigation into reports that its patient portal could not be accessed by the parents of patients aged 13 to 17. Texas law gives parents and legal guardians the right to access the medical records of their children except in specific circumstances where the child can indicate that they don’t want their information shared. The health system agreed to provide better instructions for accessing family records on its patient portal and also cited its planned migration to Epic.

Other

Federal Trade Commission Chair Lina Khan, JD says that she has used ChatGPT to contest questionable medical bills. She didn’t say how she used it specifically, but ChatGPT suggests that it can provided detailed breakdown of charges, explain how insurance applies, identify discrepancies, offer negotiation tips, and draft appeal letters.

The Madison paper covers Nurse Disrupted, which offers a virtual nursing platform. The founder and CEO of the eight-employee company is Bre Loughlin, MS, RN, a former bedside nurse and Epic executive.

Sponsor Updates

• Vyne Medical publishes a case study titled “Cloud Fax Reduces IT Burden for Large Health System.”
• Mobile Heartbeat publishes a new customer success story featuring Henry Mayo Newhall Hospital.
• Lucem Health will incorporate AccurKardia’s ECG interpretation software into its Reveal solution to identify high-risk patients.
• NTT Data publishes a new report, “Innovation Index: How North American Organizations are Achieving Growth, Value, and High Performance.”
• Nordic releases a new Designing for Health Podcast, “Interview with Margaret Lozovatsky, MD.”
• PerfectServe congratulates customers Elmhurst Hospital, Beverly Hospital, and UNC Health Rex on receiving 24 consecutive “A” grades for safety from The Leapfrog Group.
• SmartSense by Digi’s second annual Live23 user conference sees a 300% increase in attendance year over year.

Blog Posts

• Overcoming 3 top workforce challenges driving RN turnover (Inovalon)
• Caring for the Caretakers: An Interview with Medhost SVP of Human Resources, Carla Stephenson (Medhost)
• Using Automation to Improve Payer Collaboration: On Air Insights (MRO)
• Intelligent patient experiences, part 4: How effectively can your clinicians manage patient care? (Nuance)
• How to Improve Compliance Processes in RCM with Transparent Medical Coding Automation (Nym Health)
• Beyond Gratitude: Ozark Center’s Transformative Impact on Veterans’ Lives (Netsmart)
• Empower with ServiceNow Knowledge (Optimum Healthcare IT)
• Empowering Community Health and Revenue Growth: The Test and Treat Advantage for Pharmacies (OmniSys)
• Six reasons to consider cloud migration (Rhapsody)
• Biosimilars are Changing the Game (Surescripts)
• The Evolution of the CMIO Role in Hospitals & Health Systems (Symplr)
• Finding a Way: The ABC Act’s Aim for Easier Access to Caregiving Resources (Trualta)
• Don’t Miss the Opportunity: G2211 Primary Care Add On Payment in 2024 (VisiQuate)
• From Exhaustion to Empowerment: How to Alleviate Patient Burnout in Healthcare (Vyne Medical)
• Ensure Successful Service Desk Partnerships with Preparation (CereCore)

Contacts

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