Morning Headlines 11/15/23

Henry Schein Reports Third-Quarter 2023 Financial Results and Updates Full-Year Guidance

The medical supply vendor misses estimates for both revenue and earnings and lowers guidance even though the quarter was over before its October cyberattack.

UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

The company reportedly threatened to fire employees who failed to hit targets to limit the rehab care of Medicare Advantage patients to an algorithm-predicted appropriate number of days.

The Next WebMD: An LLM as Your Front Door to Healthcare

A16Z predicts that the model of Googling symptoms and then asking a medical friend or relative could be replaced by AI chatbots that could refer people to a marketplace of services offered for sale, giving the LLM company control of revenue streams worth billions.

AristaMD and Sitka Form Single Company, Secure Series C of $16.5M for the Expansion of Specialty Care Access via Electronic and Video Consultation Services

EConsult and referral management solution provider AristaMD acquires Sitka, which offers a platform for primary care providers to request video consultations from specialists.

News 11/15/23

Top News

New York Governor Kathy Hochul proposes regulations that would require hospitals to establish a cybersecurity program led by a CISO, assess their cybersecurity readiness, and develop and test response plans.

The state budget includes $500 million for healthcare facilities to upgrade their technology.

Reader Comments

From Kvetcher: “Re: investigative reporting. I would like to see more of that.” I always appreciate reader ideas for doing more, while simultaneously noting that all the writing you see on HIStalk is done by a two of us part-timers, or about 1 FTE, who have to be careful about overcommitting.

From Spock: “Re: SPACS. Maybe you’ve posted before, but I’m curious on the logic and money flow. Seems like I read every day another whose value has declined tremendously.” My SPAC opinions summarized:

1. Special purpose acquisition companies were a popular, backdoor method of going public in a “blank check merger” while offering minimal opportunities for investor due diligence, thus attracting low-quality companies whose financials could pass only superficial examination. SPAC sponsors could and did make wild, unsupported financial projections and lit up their social media accounts with self-serving bunk the SEC couldn’t do anything about it because IPO rules don’t apply to mergers. Most people haven’t noticed that the now-bankrupt WeWork went public via a SPAC merger, taking investors for a rough four-year ride as its valuation sank from $47 billion to less than $100 million while making its former CEO a billionaire (everything you need to know about SPACs is contained in that last sentence).
2. SPACs mostly benefitted their hype-spewing sponsors, who skimmed 20% or more of the overvalued proceeds immediately as their fee and then left less-knowledgeable investors ending up like Halloween night homeowners at their front doors stomping out a flaming bag of excrement .
3. SPACs were legally required to find merger partners within two years or else shut down, and mating became desperate as closing time neared.
4. The result was the companies that couldn’t pass IPO muster often failed spectacularly, leaving investors holding the bag and SPAC sponsors moving on to find new ways to move money from investor pockets to their own.
5. Some of healthcare’s big SPAC mergers were Babylon Health (went public in mid-2021 at a $4.2 billion valuation, since declaring bankruptcy for key businesses and selling parts for scrap); Clover Health (valuation dropped from $7 billion to less than $500 million); Cano Health (once valued at nearly $3 billion, now at $38 million and likely to shut down); 23andMe ($6 billion to $400 million); Butterfly Network ($3 billion to $230 million); Sharecare ($3 billion to $400 million); SOC Telemed ($1 billion to being taken private for $300 million); and ETAO ($1 billion to $17 million).
6. Struggling digital health companies were a favored SPAC target because they were already overhyping their prospects and performance, making them the perfect partner for scammy SPAC sponsors.
7. My takeaway is that SPACs were just another manifestation of greed as usual. Nobody forced investors to buy shares in obviously poor-quality companies – they did so voluntarily hoping to find a greater fool down the road who would buy them at an even more inflated price.

From Bergamoot: “Re: HIMSS. What business are they in selling tech services to Taiwan?” HIMSS sold its annual conference and now seems to harbor ambition for doing global consulting, which doesn’t seem like a core competency of a membership group. They signed a deal with Taiwan’s national insurance organization to provide “subject matter experts, thought leadership, and advice” in cybersecurity, analytics, and national education programs. HIMSS would not come to my mind in thinking of organizations who provide these services regularly and arguably well, although I would likely list the names of companies that support HIMSS financially and now find themselves as its competitors. Maybe HIMSS sees revenue opportunity in offering a marketplace for vendors who pay it for matchmaking them with clients.

From Horse Pistol CIO: “Re: CHIME. Made a pretty big tactical error by running its fall forum from Friday to Sunday. The number of CIOs who exited early was palpable. The final event on Saturday night was basically a vendor fest which is not ideal for anyone. It’s probably not surprising that folks would prefer to not give up an entire weekend for a conference and then have to go to work the very next day. Rumor was that it ran through the weekend due to prior feedback and that they won’t do it again. To me it was a big miss. Lots of heavy hitters were gone by Friday. Bummer.”

HIStalk Announcements and Requests

It’s funny how much stupider my Alexa devices and Google searches seem now that I’m using ChatGPT to selectively replace them.

Webinars

November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.

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

Acquisitions, Funding, Business, and Stock

A former employee’s LinkedIn post says that Health Catalyst laid off another 120 employees this week, as suggested in last week’s earnings call in which the company said it would lay off 10% of its people in late Q4. The same call touted the company’s high level of employee engagement and winning five “best places to work” awards. HCAT shares are down 19% in the past 12 months versus the S&P 500’s 12% gain, valuing the company at $456 million.

Henry Schein reports Q3 results: revenue up 3.1%, adjusted EPS $1.05 versus $1.09, falling short of estimates for both even though the quarter was impacted by its October cyberattack. The company lowered full-year revenue and earnings estimates. It says it will file a cyber insurance claim, but its policy has a $60 million limit. Schein expects to restore online ordering next week, which represents most of its business, and said on the earnings call that it hopes to regain the 10 to 15% of its sales that were to customers who order exclusively electronically without a sales rep who took their business elsewhere when systems were offline.

Well Health reports Q3 results: revenue up 40%, adjusted EPS $0.05 versus $0.07.

Hackensack Meridian Health signs a partnership with Amazon’s One Medical primary care service, the latest of a couple of dozen big health systems opening brick-and-mortar locations together, sell One Medical memberships to employers (the same package that Amazon Prime members get for $99 per year), and then the health system gets the referrals for specialty care from all over the state in claiming to offer coordinated care and connected technologies. Amazon doesn’t like low-margin business, so it would be interesting to see contract details to know whether the health systems are paying Amazon for referral exclusivity or a share of the business it generates. Also, this deal seems to be based on signing up employers to pay the membership fee, which would seem to keep the health system from getting referrals of uninsured patients.

MIT spinoff Layer Health comes out of stealth mode with $4 million in funding. Its Distill product uses AI to use unstructured patient data for a variety of chart review tasks.

Sales

• Presbyterian Hospital (NM) chooses the social services referral platform of Unite Us.

People

Availity hires Sean Keneally, MBA (Elevance Health) as COO.

Announcements and Implementations

Australian Capital Territory Government notes the one-year anniversary of its Epic go-live, listing statistics about MyDHR use, internal messaging, and turnaround time for diagnostic studies.

Surescripts applies to become a QHIN.

A Stat investigation finds that UnitedHealth group used a computer algorithm to cut off rehabilitation services to Medicare Advantage plan members, threatening to discipline or fire employees who failed to hit a 1% variation target even when Medicare coverage rules warranted more days of service. Ironically, the algorithm that was developed by NaviHealth – a company that UHG acquired in early 2020 – was designed to help patients meet their rehab goals, not to cut off their financial access to it. Algorithm-denied care isn’t exactly the poster child that AI healthcare proponents are seeking.

Marketing and PR firm Amendola Communications wins awards for its work with KeyCare, DrFirst, and Equality Health.

John Muir Health implements Epic integration with Ambience Healthcare’s ambient AI scribing system, which allows clinicians to view their Epic schedule in the Ambience app, record audio of their visits on desktop or mobile, and immediately view and edit AI-generated documentation within Epic.

FDA designates Mednition’s AI early sepsis detection solution as a breakthrough device.

Mercy launches The Chen Chemotherapy Model, which sends a daily text message to outpatient chemotherapy patients and uses their responses about symptoms to proactively manage their care. It was named after former Mercy data scientist Jiajing Chen, PhD, MPH, who developed it before dying of cancer in January 2023 at 42.

Other

The American Medical Association reviews at its interim house of delegates meeting a previously rejected member proposal to ban the corporate practice of medicine. A radiologist member who spoke on behalf of reviewing the measure said,

We are being picked clean by private equity. There are people who don’t know where their next paycheck is even going to come from because their groups have been flipped so often … [This resolution] is protecting both physicians and patients, it is preserving physician autonomy and preventing burnout. Seventy-four percent of physicians [are] employed; just four years ago it was 50 percent. Private equity has spent $1 trillion in the last decade on acquisitions in buying medical practices. We need to have something to talk about with respect to private equity at this meeting.

Andreessen Horowitz predicts that the “Google –> WebMD –> Friend” protocol of patients entering the health system via a doctor friend or relative will be replaced by personalized large language models that will use a few rules to send instructions to third-party software while simulating empathetic guidance. It describes a potential experience in referencing the Baymax healthcare robot from the movie “Big Hero 6,” which it argues could give companies control of revenue streams worth billions of dollars in connecting an LLM to a marketplace of services that consumers can book directly:

One day, you wake up with a hint of a headache and a sniffle. You sneeze. What do you do next? You turn to your Baymax-like app, input your symptoms, and after a few follow up questions, it predicts— given your current location, the weather, your recent sleep scores, your diet, and your personal trends—that you’ve got allergies. It offers you a same-day appointment with a nearby allergist covered by your insurance to confirm the diagnosis. In the meantime, it recommends you try an over-the-counter allergy medication, offering to have it delivered to your house. It orders extra tissues for you, for good measure.

Contacts

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

Morning Headlines 11/14/23

Governor Hochul Announces Proposed Cybersecurity Regulations for Hospitals Throughout New York State

New York State will require hospitals to establish a cybersecurity program, implement protective measures, assign a chief information security officer role, and implement two-factor authentication for external access, with the plan including $500 million in available grants to help fund compliance.

Dutch hospital uses AI to answer patients’ questions

Groningen University’s teaching hospital UMCG rolls out chatbot to help answer patient questions, which scans their records and providers a clinician-reviewed response in what the hospital says is the first such use in Europe.

How Generative AI Could Help Us Predict the Next Pandemic

Harvard researchers develop an AI tool that can predict the emergence of concerning variants of COVID-19 and other viruses.

A majority of Americans are optimistic that AI will improve healthcare in 2024

A survey of randomly sampled Americans find that half expect AI to create major advancements in healthcare next year, especially in diagnosis and access, although few of them would prefer to work with a doctor who uses AI extensively.

Readers Write: Navigating the Telehealth Regulatory Labyrinth

Navigating the Telehealth Regulatory Labyrinth
By Sheeza Hussain

Sheeza Hussain is chief growth officer of SteadyMD of St. Louis, MO.

Telehealth has the potential to amplify its impact on healthcare access while further reducing costs, but a web of state regulations is hindering that promise.

Telehealth became a household term for millions of Americans in 2020, emerging as a vital component of healthcare delivery. It helped bridge the gap caused by clinician shortages, tackled certain social determinants of health, and facilitated care for rural patients who otherwise struggle to access it.

However, the rapid expansion of telehealth has exposed a glaring issue – a labyrinth of regulatory and legal obstacles. State licensure variability, reimbursement policies, telehealth parity laws, cross-state regulations, and other hurdles continue to impede adoption.

Licensure is just one complicating factor in the telehealth regulatory maze. Many states have differing regulations on nurse practitioner scope of practice, with variance in whether NPs can operate independently, require physician oversight, or are restricted entirely. This patchwork hinders multi-state advanced practice clinician telehealth.

Additionally, certain modes of virtual care like asynchronous visits face ambiguity, as some states allow reimbursement while others prohibit or fail to address it. Like licensure, these state-by-state discrepancies in nurse practitioner and asynchronous visit policies make scaling telehealth availability and minimizing legal risk complex for providers. Overcoming the regulatory headaches requires close tracking of each state’s evolving rules.

Among the three primary challenges, the perplexing variations in state licensing rules are the most significant.

Healthcare providers are required to be licensed to practice in the state in which their patient resides. In some cases, patients are forced to cross state borders to receive telehealth services from their chosen physicians.

The disparities in telehealth policy between states are glaring. For instance, North and South Dakota, as well as Virginia and West Virginia, don’t see eye to eye on telehealth regulations. This patchwork of policies is emblematic of the broader problem – 50 states, each with its own set of laws, medical communities, and stakeholders, all contributing to the complexity of telehealth regulation.

The existing state-by-state licensure processes are antiquated, leaving telehealth companies that operate in multiple states grappling with a complex and ever-changing regulatory landscape. A common requirement is that telehealth providers must hold licenses in the state where their patients are located. However, this doesn’t simplify telehealth; it complicates it further. Most providers are licensed only in one or two states, limiting their usefulness to telehealth companies operating across several states.

Obtaining licenses in additional states is a costly and time-consuming endeavor for telehealth companies. They must build a roster of multi-state providers, carefully manage supply and demand, and ensure compliance with the laws of each state they serve.

Calls for modernizing licensure portability have gained momentum, with some advocating for a standardized federal system akin to driver’s licenses. However, this transformation won’t occur overnight. As telehealth becomes increasingly integrated into healthcare, state regulations may eventually become more uniform, but this change is unlikely to happen soon. The healthcare industry can advocate for greater licensure portability, such as the implementation of a standardized federal licensing system, but providers need relief now.

In the meantime, telehealth providers are seeking alternative solutions. Many are opting to partner with telehealth infrastructure providers that guarantee compliance with state laws, recruit and manage providers, and stay current with shifting regulations. By entrusting an external partner to navigate the intricate regulatory landscape, telehealth providers can focus on what truly matters – providing the best care to their patients.

Curbside Consult with Dr. Jayne 11/13/23

One of my professional organizations has a forum for members to help us stay connected about hot topics. I got my chuckle of the day when one member referred to scope creep on federal information blocking rules by saying the content “has now metastasized” to a document that’s nearly 80 pages.

I’ve been in the consulting world for so long that I assume that scope creep will be part of nearly every project. However, when you think of scope creep in terms of being a cancerous growth, it reminds you just how insidious it can be. For those of us who have been around the informatics block for a while and have some implementations under our belt, we understand the phenomenon.

Sometimes scope creep happens because the initial project scoping wasn’t done properly. The “creep” represents efforts to try to get features or requirements added to the project that should have been there in the first place.

How did they get missed, you ask? In my experience, it tends to be combination of factors. Sometimes the right shareholders aren’t at the table when the project is being defined. I’ve seen that happen plenty of times when IT folks are tapped to run what are essentially clinical or operational projects. I think that organizations are getting better at this, however, forming dyads or triads of leaders to ensure that projects have the right people at the helm to deliver results.

You have to be careful with this approach, though, since the old adage of “too many cooks in the kitchen” can easily happen in healthcare technology projects. Having unclear leadership can also lead to problems with prioritization of work efforts and challenges when there are identified barriers that need to be addressed. I’m personally a big fan of formal project management documents that spell out the who, what, when, where, why, and how of a project. It’s essential to capture the goals of the project, expected outcomes, and the change control process if you want to avoid messes later. When you don’t have that kind of documentation, it’s easier for people to claim something was in scope when it wasn’t, or to claim that the project team didn’t deliver when the expectations weren’t well documented.

One of my favorite ways to combat scope creep is to make sure that project deliverables are tied to specific budget items, and that all of those items roll up into the master budget so that everyone can have clarity on how much a project is costing and where the money is coming from. This requires that the project includes people who have solid skills at estimating work accurately and who have a good understanding of their teams’ productivity. I’ve worked with managers who claim a project will be an 80-hour build when it really takes less than 10, which does the project a disservice. Conversely, people who underestimate the complexity of a task or who underestimate their teams’ ability to deliver can create havoc on a massive scale.

Even when a project is properly scoped and estimated, having strong documentation of these estimates and costs makes things easier to manage later when people ask for additions to the project. I’ve been known to ask them to estimate the work effort for their proposed addition, then hand them the budget and timeline documentation and ask them what they propose to alter in order to make their request a reality. Does your department want to pony up the money for us to hire contractors to build the additional content you didn’t mention during the original scoping meetings? Or do you want to give up some other content in exchange for what you now realize is a must-have? Those aren’t fun conversations by any means, but people tend to take them less personally when there’s data in front of them than when it’s just the CMIO telling them no.

There is always going to be a certain amount of scope creep on a project, and usually I see that when the team uncovers an element that they weren’t expecting, or a key element of the project doesn’t work as planned. For example, on a big EHR project I was brought into when there was a lot of leadership infighting, we discovered that laboratory interfaces had been deliberately excluded from the scope due to budget constraints. It’s ridiculous to try to do an inpatient EHR project without laboratories, so we had to add them in, of course after educating the steering committee why they shouldn’t have allowed them to be excluded in the first place. That’s a bigger miss than you typically see on a project like that, but a good example of why at least some percentage of contingency overhead should be included in every project.

When there’s an excessive amount of scope creep, or when organizational politics become too big of a distraction for the project team, I’ve been known to suggest that the project be put on hold while it is re-scoped. Sometimes that approach is the proverbial shot across the bow that people need to get their attention, or to get them to understand how big of a concern it is to handle requests for changes to a project that’s already in flight. Especially in organizations where there are dozens of projects running in parallel, it’s understandable that people might be having trouble keeping track of which elements are part of a given project and which might be included as a separate but parallel effort.

That illustrates why communication plans are so important, so that it’s easier for people to understand what is in our out of scope or to find the information if they generally don’t know. Making sure people understand project timelines and budgets is a key part of this. I’ve found it’s harder for people to ask that new requirements be added to the scope when they can clearly see that the project calendar is running in a yellow/orange status, or that the budget is squarely in the red zone. Sometimes the people who ask for additions aren’t in the weeds with a project, and being able to quickly show them where things stand is key.

I’m working with some relatively new clinical informaticists who are honestly some of the smartest people I’ve ever met. However, most of them don’t have a tremendous amount of experience in project management or the sausage-making that happens when you try to bring a new project live with actual healthcare organizations. I’m trying to teach them as much as I can about the behind-the-scenes work that makes the difference between a project that feels like a slog and one that just flows. Some of that you just have to learn through experience, though, and I don’t envy them the knocks that they’ll undoubtedly take as they move forward in their careers. There’s a certain level of “been there, done that” that we all have to reach, but I’m glad I can help them when the going gets tough.

What’s the worst scope creep you’ve ever seen in a project? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/13/23

Thoma Bravo Completes Acquisition of NextGen Healthcare

The private equity firm takes NextGen Healthcare private in closing its $1.8 billion acquisition.

Doximity Announces Fiscal 2024 Second Quarter Financial Results

The medical professional network beats expectations for revenue and earnings.

MUHC clinical platform crashes, patient appointments cancelled

A software update takes down the Oacis clinical platform of McGill University Health Centre. 

Cano Health Announces Financial Results for the Third Quarter 2023

A $92 per share loss by the value-based primary care company raises questions about its ability to remain in business.

Monday Morning Update 11/13/23

Top News

Doximity reports Q2 results: revenue up 11%, adjusted EPS $0.22 versus $0.17, beating Wall Street expectations for both and sending shares sharply up.

DOCS shares are down 32% in the past 12 months versus the SP& 500’s 12% gain, valuing the company at $4.4 billion.

The company laid off 10% of its employees and reduced revenue guidance in August 2023.

Reader Comments

From Quite the Tenses: “Re: NextGen Healthcare. Thoma Bravo closed on its acquisition and immediately announced a 20% RIF in a town hall meeting. Details to be shared next week.” Unverified, but reported by multiple readers. TB paid $1.8 billion to take NextGen private. The company’s Mirth integration product line didn’t get a lot of airtime in the announcements even though it launched a cloud-based version a few months ago, so I’m wondering how that fits into the new owner’s expectations.

From Big Night: “Re: Amazon One Medical. Why do you call it concierge medicine?” Your $99 per year gets you no medical services except for telehealth visits, and should you show up in one of the company’s limited number of physical locations, either you or your insurance will be paying full price. One Medical’s annual fee was $199, so the only thing new is the $100 discount through Prime. The price is low for concierge medicine, but greater than the $0 memberships that most primary care practices charge. The company also offers Amazon Clinic, which is a marketplace for the telehealth services of paying advertisers. Everybody’s getting overly excited about Amazon’s monetizing of its $4 billion acquisition of One Medical early this year, but it could be a minimally seismic event like when it bought Whole Foods.

HIStalk Announcements and Requests

Poll respondents confirm that it is common for health systems to shut down community-needed services that aren’t profitable.

New poll to your right or here: Which position seems to be losing popularity or influence the most in health systems?

I appreciate the comments of Kat McDavitt and Lisa Bari of the Health Tech Talk Show, who recapped my Olive implosion summary and described HIStalk as “still the reigning number 1 health tech hotsheet. Despite the 1998 UI.” That appearance-shaming assessment is accurate and I am pleased in an “all cattle, no hat” sort of way. I like to think of HIStalk’s quirks as being the velvet rope that industry leaders happily sidestep to join their peers in consuming what’s inside, while others flee for prettier, shorter content with all the abbreviations spelled out. 

My polls are mostly for entertainment and to generate timely reaction, but vendors who wrap advertising around a poll they have conducted should include this information to  support validity and thus newsworthiness:

• The way you chose and invited respondents and whether random sampling was involved.
• The sample size and response rate.
• The method of delivery.
• A sample survey instrument so it can be reviewed for bias, quality of wording, and verification that the lofty conclusion is supported by the actual questions.

Webinars

November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.

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

Acquisitions, Funding, Business, and Stock

Value-based care and population health management company Cano Health reports Q3 results: revenue up 19%, EPS –$91.87 versus $0.23, sending shares sharply down as investors question its ability to stay in business. The company’s market cap is down to $32 million. It went public via a SPAC merger in November 2020 at a $4.4 billion valuation.

Elucid, whose AI-powered imaging analysis system assess cardiovascular diseases, raises $80 million in a Series C funding round.

People

Flatiron Health promotes Nathan Hubbard, MBA to chief business officer.

Courney Starnes, MBA (Saint Luke’s Health System) joins Kaleida Health as SVP/CIO.

CommonSpirit Health promotes Jamie Trigg, MSITM to system VP of primary EHR systems.

CHIME names Shafiq Rab, MD of Tufts Medicine as its 2024 John E. Gall, Jr. CIO of the Year.

Announcements and Implementations

A Healthcare IT Leaders survey of CHIME members finds that while AI adoption is in its early stages, two-thirds plan to implement or pilot projects with 12 to 24 months. Half expect AI to help alleviate worker shortages, while nearly all involve clinicians in their AI decisions.

In Canada, McGill University Health Centre goes back to paper and cancels appointments as its Telus Health Oacis clinical system crashes following a software update.

An AI system is used for the first time to autonomously negotiate a non-disclosure agreement between to companies with no human involvement, which took just a few minutes.

A new KLAS report finds that digital pathology is used in only 5% of US cases, but early users anticipate benefits such as better patient care, increased efficiency for pathologists, faster image access, reduced storage and delivery costs, and new opportunities for reference labs to attract hospital clients. They also foresee digital pathology paving the way for AI-assisted diagnostics, case screening, and improved quality assurance. The majority of these early adopters, typically having 30 or more pathologists, are progressively implementing digital pathology, initially focusing on applications that simplify pathologists’ tasks.

Privacy and Security

Tri-City Medical Center (CA) diverts ambulances following an unspecified cyberattack that is rumored to involve ransomware.

Other

The Verona paper summarizes its annual update from Epic:

• The company added 1,500 employees in 2023.
• Epic will open three new office buildings in 2024 that will provide 1,100 spaces.
• A sixth campus will be opened within two years.
• Software releases for 2023 focused on physician burnout and nurse staffing shortages, which included work with generative AI.
• The company trains 850 people on campus each week.

Sponsor Updates

• MRO sponsors a Stuffed Animal for Charity event at the recent HFMA Region 9 conference, benefiting Our Lady of the Lake Children’s Hospital and Ochsner.
• HIStalk sponsors exhibiting at RSNA 2023, which will take place November 26-30, include Agfa HealthCare, Elsevier, Nuance, QGenda, Rhapsody, Sectra, Visage Imaging, and Wolters Kluwer Health.
• Methodist Le Bonheur Healthcare adopts Optimum Healthcare IT’s IT Service Management.
• Wolters Kluwer Health launches Lippincott Partnership for Nursing Education and Testing, which offers a full curriculum suite of educational products and services for prelicensure nursing programs.

Blog Posts

• 3 strategies Cerner EHR-based organizations are using to improve patient access to healthcare (Notable)
• Intelligent patient experiences, part 3: How quickly can your patients get answers and advice? (Nuance)
• Apollo’s Curse: When AI Predicts and Doctors Resist (Nordic)
• Capturing the right data to power better healthcare (Wolters Kluwer Health)
• Nurses of Note 2023: The RN Case Manager (PerfectServe)
• Why Healthcare Organizations Should Prioritize Centralized On-Call Scheduling (QGenda)
• Shaping the Future of IT Contracting in Healthcare: A Tale of Two Organizations (Revuud)
• RSNA 2023 spotlight: Sectra empowers improved work-life balance for radiologists (Sectra)
• Congress Eyes Policies to Bolster Pharmacists as Care Providers (Surescripts)
• The Evolution of the CMIO Role in Hospitals & Health Systems (Symplr)
• Visage Soars with CloudPACS at RSNA 2023 (Visage Imaging)
• California’s Path to Better Healthcare: Understanding the CA Data Exchange Framework (DxF) (Zen Healthcare IT)

Contacts

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

Morning Headlines 11/10/23

IHS Selects New Enterprise Electronic Health Record System

Indian Health Service chooses General Dynamics Information Technology and Oracle Health for its new EHR, which will replace its VistA-based RPMS.

Attorney General James Secures $450,000 from Medical Company Providing Services in Western New York for Failing to Protect Patient Data

US Radiology pays $450,000 to settle New York State charges that outdated computer hardware allowed a ransomware attack that exposed the information of 92,000 state residents.

Elucid Raises $80 Million in Series C Round Led by Elevage Medical Technologies

AI-powered imaging analysis software company Elucid announces $80 million in Series C funding, bringing its total raised to $121 million.

News 11/10/23

Top News

Indian Health Service chooses General Dynamics Information Technology and Oracle Health for its new EHR, which will replace its VistA-based RPMS.

The 10-year contract is valued at up to $2.5 billion.

HIStalk Announcements and Requests

Listening: London-based all-female Hawxx, whose chaotic, cathartic punk-tinged alt-metal music addresses themes such as mental health struggles, societal norms regarding appearance and femininity, and why metal needs marginalized voices on stage and in the audience. The music is loud but smart, sometimes resembling Rage Against the Machine and at other times Nightwish. 

Webinars

November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.

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

Acquisitions, Funding, Business, and Stock

Amazon launches One Medical for Prime, which offers access to its One Medical primary care business for $99 per year, which covers all virtual care visits. It offers little benefit for in-person primary care visits at the 24 One Medical locations since those will continue to be billed to insurance or as out-of-pocket costs. Non-Prime members can continue to sign up for $199 per person for an annual membership, so the Prime offer is really just a $100 annual discount. This would be a good time to remind folks of the difference between direct primary care (you pay your doctor a flat monthly fee that includes most services, easy access, and no use of insurance) versus concierge medicine (you pay to skip the line to see doctors who still bill your insurance or you personally at their usual rates). I have the former and question the value of the latter.

Eleos Health, which offers behavioral healthcare providers AI-powered clinical documentation and insights software, raises $40 million in a Series B funding round.

Former Meta COO Sheryl Sandberg and other high-profile investors launch Cercle, whose platform organizes unstructured medical data into a standard format to help clinicians develop personalized treatment plans for women’s health, especially fertility care.

CPSI announces Q3 results: revenue flat, EPS –$0.24 versus $0.15, beating earnings expectations but falling short on revenue. CPSI shares have lost 52% in the past 12 months versus the Nasdaq’s 29% gain, valuing the company at $164 million.

Sales

• Delaware Department of Health and Social Services chooses Findhelp to help residents find substance use disorder and mental health services.
• Resilience Healthcare will implement Altera Digital Health’s Paragon EHR and its Ventus contract management, compliance, and coding solutions.
• Mass General Brigham chooses Best Buy Health to support its hospital at home program with its Current Health care-at-home platform, coordination services, and personal emergency response solutions. 

People

Jeff Park (WellDyneRx) joins Waltz Health as president.

Announcements and Implementations

Enterprise Health announces the Wellby AI assistant to its occupational and employee health solutions, providing clinicians with a concise medical records summary, preparation of standard referral and return-to-work letters, and a proposed care plan based on encounter details.

Health system owned Truveta announces availability of 57 million clinical observations from 2.7 million ECG reports and 1.7 million de-identified patients

KLAS takes its first look at Epic Payer Platform, which extracts clinical data from providers and sends it to payers, finding that all six interviewed customers are satisfied and would buy the solution again.

Privacy and Security

US Radiology pays $450,000 to settle New York State charges that outdated computer hardware allowed a ransomware attack that exposed the information of 92,000 state residents.

Cook County Health notifies 1.2 million patients that their information was compromised in a data theft incident involving its transcription vendor Perry Johnson & Associates. The health system has terminated its relationship with the company.

Five Ontario hospitals whose IT shared services organization was taken offline in a ransomware attack on October 23 say they won’t have systems fully restored until late December. The hospital declined to pay the ransom demanded by the hackers, who have been publishing their patient data online.

Sponsor Updates

• Fortified Health Security and Nordic sponsor Valley Presbyterian Hospital’s golf tournament.
• Inovalon expands its Schedule Management software to include management of third-party agency staff.
• Ampla Health (CA) optimizes operational workflows using EClinicalWorks V12.
• Everbridge secures a new patient in the field of AI, relevant to technology used in analytics dashboards for critical event management software.
• Medical history platform vendor Hona will use Particle Health’s API for medical record retrieval outside of the provider’s EHR.
• First Databank names Andrew Anderson integration specialist, Sarah Callis technical writer, and Pranav Acharya advanced software engineer.
• Clinical Architecture publishes a new episode of its “The Informonster” podcast titled “Documentation in the OR with AORN.”
• Ushur’s Customer Experience Automation solution is listed on the Five9 CX Marketplace.

Blog Posts

• Understanding Nurse-to-Patient Ratios and How They Affect Quality of Care (SnapCare)
• Visage Soars with CloudPACS at RSNA 2023 (Visage Imaging)
• Embracing Technology for Startup Weight Loss and Medical Spa Clinics (EClinicalWorks)
• Addressing Medicare Bad Debt Reimbursement Issues in Healthcare (FinThrive)
• EHR Essentials: 5 Proven Steps for a Successful Epic Implementation (Healthcare IT Leaders)
• Considering Cashless Check-Ins for Your Front Desk? (Impact Advisors)
• Can Software Testing Deliver ROI? (Keysight Technologies)
• What to Ask When Choosing a Healthcare Interoperability Partner (Medhost)
• Giving nurses a voice in EHR launch at Boone Health (Meditech)

Contacts

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

EPtalk by Dr. Jayne 11/9/23

Several readers messaged me trying to get my thoughts on exactly which companies I think might be “in bad shape” following my recent discussion of the Olive shutdown.

The short answer is that a lady never tells, but readers didn’t even have to wait a day to see a non-healthcare answer, as WeWork filed for bankruptcy. The company had a pre-COVID valuation of $47 billion and has had to cope with the upheaval that the pandemic brought to the office-sharing and remote work space. Now there are questions as to how the company’s bankruptcy will impact the commercial real estate market, since the company had billions of dollars in lease agreements, including those for seven million square feet of office space in New York City alone.

One reader sent me the recent Block (formerly Square) shareholder letter, which mentions that they will cap employment at 12,000 people “until we feel the growth of the business has meaningfully outpaced the growth of the company.” They went on to say, “We know the inverse is true today.” A quick web search indicates that the company has about 1,000 more employees than that cap, so I hope they have the foresight to buff up their resumes.

As a public company, Block is required to release certain information and there’s the potential for shareholders to hold the company’s leadership accountable for performance. Block’s futures are closely tied to the retail economy, so it will be interesting to see what happens over coming months given the current state of things in the US.

Speaking of post-COVID challenges, a couple of my colleagues who are infectious disease specialists brought to my attention that the Centers for Disease Control and Prevention is working on an update to its Isolation Precautions Guidance, last updated in 2007. The newest document isn’t due to be complete for several more months, but a draft was finalized last week. It recommends that masks be worn to reduce respiratory pathogens such as influenza and COVID-19, but the mentioned masks are medical masks or surgical masks that aren’t as good at preventing transmission as N95 and other respirators. There’s great concern among physician and nursing leaders that the relatively weak recommendations will allow hospitals to go for the cheapest option rather than making sure that employees are adequately protected.

There’s a lot of discussion about burnout and turnover among frontline clinicians. I would offer a suggestion that one way to make employees feel more valued and appreciated would be to provide higher-level protection to anyone who wants it, without making them jump through hoops or reuse personal protective equipment which has already been anecdotally reported this respiratory season. I’ll take a giant pack of N95s or KN95s over a pizza party any day.

I had a lot going on at the end of October, so I missed the fact that the Federal Communications Commission (FCC) voted to begin the process of restoring net neutrality regulations that would keep US internet providers from slowing down services on their networks based on content. As expected, broadband providers plan to fight the effort, claiming that it is burdensome and that the effort is a regulatory overreach by the FCC. Public comments on the proposed rule are open and the earliest we’ll see a potential change would be 2024. If you’re looking for some scintillating bedtime reading, the Notice of Proposed Rulemaking and a fact sheet are available for your perusal.

Also in my October mail bag was an overview of a new proposed rule that details “disincentives” for information blocking that was recently published by the US Department of health and Human Services. The proposed penalties include losing “meaningful user” status in a given EHR reporting period, which leads to economic penalties; receiving a zero score for Promoting Interoperability under the Merit-based Incentive Payment System (MIPS); and restrictions on participating in the Medicare Shared Savings Program. The proposed rule also describes the process to occur when an organization is accused of information blocking.

It still baffles me that organizations are struggling to get on board with this, since in the vast majority of situations, having greater access to patient data benefits patients and clinicians. I understand the financial ramifications and the desire for organizations to want to restrict competition, but it just comes off as being anti-patient at this point. Physicians in my area are happy to name and shame when organizations do it, and I’ve seen those revelations steer referral patterns away from uncooperative organizations. More information can be found on the related HealthITbuzz blog.

I recently became aware of a new startup that is working to mitigate how often artificial intelligence systems hallucinate or make up information. Vectara has about 30 employees and has raised $28 million in seed funding. Its founders include former Google AI researchers with deep expertise in the field. The company cites the rate of hallucination by AI platforms as ranging from 3% (OpenAI) to 27% (Google’s Palm chat). Meta’s systems rang in at 5%. The company plan to offer solutions that will mitigate the risks of hallucination, bias, and copyright infringement. Putting on my marketing hat, I like their logo, which feels clean and has forward mobility, and the use of color just kind of grabbed me. Including such a spectrum definitely reduces the need for people to debate which Pantone color is the “right” one.

A reader also asked me what I thought about the recent news that Cigna is considering an option to jettison its Medicare Advantage business. Perhaps Cigna has figured out, as have others, that it’s becoming harder to make a buck in the Medicare Advantage space while keeping patients happy and avoiding pressure on physicians and providers to overstate patients’ complexity. Medicare Advantage only comprises 4% of the company’s external revenue, so it makes sense for leaders to consider bringing in some cash so the company can focus its efforts elsewhere. There’s also the tidbit where Cigna is paying over $170 million to settle claims about its previous track record of trying to make patients seem sicker than they really are. As I re-enroll with insurance plans, I’m avoiding Medicare Advantage because the rewards don’t seem to be worth the administrative headaches.

Is your organization doubling down on Medicare Advantage or have they decided to pursue other interests? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/9/23

Behavioral Health AI Leader Eleos Health Raises $40M Series B Round to Expand CareOps Automation Footprint

Eleos Health, which offers behavioral healthcare providers AI-powered clinical documentation and insights software, raises $40 million in a Series B funding round.

Health AI startup Cercle debuts with backing from Sheryl Sandberg

Former Meta COO Sheryl Sandberg and other high-profile investors launch Cercle, which uses AI to support women’s health and organizes unstructured medical data into a standard format to help clinicians develop personalized treatment plans.

Sauk Prairie Healthcare is the latest company hit with cyber attack

Sauk Prairie Healthcare (WI) restores its computer systems after a cyberattack last week forced it to initiate downtime procedures and reschedule appointments.

Therapy iQ Secures $1.5 Million in Seed Funding to Revolutionize Mental Health Practice Management

Mental health practice management startup Therapy IQ raises $1.5 million in seed funding.

Healthcare AI News 11/8/23

News

OpenAI announces significant new ChatGPT features at its first developer conference, most significantly the ability for users to create a tailored version of ChatGPT – called, somewhat confusingly, a GPT – to perform specific tasks. User-created GPTs can be shared or sold via a GPT Store that OpenAI will launch later this month.

Samsung introduces Gauss, its generative AI model.

Business

Smart stethoscope maker Eko Health earns UK regulatory approval for its AI-enabled tool for the evaluation of heart failure, valve disease, and atrial fibrillation, which Imperial College London will deploy to 100 GPs who will use it in conjunction with the company’s digital stethoscope. The system is sold in the US under the name Sensora.

Agamon Health  will work with Mayo Clinic to extend its offering into cardiology, where it will enhance patient adherence to follow-up.

Former Meta COO Sheryl Sandberg and other high-profile investors launch Cercle. The company uses AI to support women’s health, especially within fertility care, and organizes unstructured medical data into a standard format to help clinicians develop personalized treatment plans.

Israel-based Eleos Health, whose automated scribing solution turns behavioral health conversations into documentation and clinical insights, raises $40 million in a Series B funding round.

Research

Researchers find that ChatGPT does a reasonably good job in answering consumer questions about lifestyle-related conditions, making it appropriate for patients who are waiting on a doctor’s appointment.

Other

Experts in India write that integrating AI into India’s healthcare ecosystem could significantly enhance service delivery and patient care, though it requires overcoming challenges related to data, policy, and infrastructure.

Adweek reports that a hospital shut down its marketing team over compliance problems after it tested ChatGPT.

A Washington Post opinion piece by Leana Wen, MD, MSc describes Kaiser Permanente’s use of AI to flag patients whose condition is deteriorating using near real-time data whose patterns might otherwise be overlooked. She says that KP’s key difference is that it sends the alerts to an offsite team of nurses to decide whether the hospital’s rapid response time should be deployed. The original study she references was published in November 2020.

CNN says that MSN.com and Microsoft Start are featuring bizarre, inaccurate stories that are generated by AI instead of the editors it has fired. The company published an article about a woman’s death that it lifted from The Guardian, then added a “pathetic, disgusting” poll that invited readers to speculate on whether she died by murder, accident, or suicide. One of the laid off editors says the company features stories from small, unreliable sources that provide little information about their ownership or editorial standards. The story above that called a deceased NBA player “useless” was speculated to have resulted from AI that translated the original source’s article from English to another language and back again to hide plagiarism.

Contacts

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

Morning Headlines 11/8/23

Bain to Buy Guidehouse in $5 Billion Deal

Bain Capital will acquire healthcare consulting firm Guidehouse from Veritas Capital for $5.3 billion.

Kythera Labs Announces $20 Million Funding to Accelerate Growth of its Wayfinder Data Technology Platform

Healthcare data insights company Kythera Labs raises $20 million in a Series A funding round.

23andMe data theft prompts DNA testing companies to switch on 2FA by default

The recent theft of 23andMe customer data prompts the company and several competitors to begin requiring customers to use two-factor authentication when signing into accounts.

News 11/8/23

Top News

Surescripts acquires ActiveRadar, a prescription drug benefits data company that identifies therapeutic alternatives.

ActiveRadar’s original iteration was launched by Safeway Food Stores to help its union employees save money on prescription drugs. It was later sold to a private equity firm and rebranded as RxTE, ultimately becoming a standalone company ActiveRadar in 2017.

Reader Comments

From Poindexter: “Re: Amazon Clinic. I received this email. It’s a big step for Amazon.” The service, which recently expended to cover all 50 states, is not all that innovative since it’s just a virtual marketplace for Amazon’s telehealth partners. Still, Amazon’s reach and experience standardization should boost the business of those participating companies and make telehealth a more widely known option. Amazon sells $50 billion worth of ads each year with high margins, renting online space to feature “sponsored products,” company stores, and display ads within its store pages that steer Amazon customers to bigger-spending vendors, so this aligns with their strategy. Amazon says that 60% of its sales come from independent sellers, and some experts think its ad business will even surpass its cloud revenue.

From Chief Pixel Herder: “Re: chief digital officer. I read that the health system job title is being phased out just about as fast as it was phased in.” It’s probably not a good time to hold a newly created C-level position in money-challenged health systems whose primary expense is labor. I wouldn’t expect them to revert back to old titles for chief digital officers and chief innovation officers, but I can see eliminating those folks who occupy newly created positions. Health systems love chasing trends like making everybody and their brother a VP and now a C-leveler, but at some point the suit proliferation becomes embarrassing when pleading poverty from atop extravagant buildings.

From Sveltese: “Re: Olive. A friend worked for them, his job being to automate the denial of prior authorization requests.” That wouldn’t surprise me, in the vein of the brightest minds of a generation spending their days getting people to click on ads. Put your money on insurers versus patients and doctors in choosing a prior authorization winner.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor QGenda. The Atlanta-based company revolutionizes healthcare workforce management everywhere that care is delivered. QGenda ProviderCloud, a purpose-built healthcare platform that empowers customers to effectively deploy workforce resources, includes solutions for scheduling, credentialing, on-call scheduling, room and capacity management, time tracking, compensation management, and workforce analytics. In 2022 and 2023, QGenda won Best in KLAS for Physician Scheduling, as well as Nurse and Staff Scheduling. More than 4,500 organizations, including leading physician groups, hospitals, academic medical centers, and enterprise health systems, use QGenda to advance workforce scheduling, optimize capacity, and improve access to care. Thanks to QGenda for supporting HIStalk.

Lorre’s email has been on the fritz for a few weeks, we belatedly discovered, as emails to her histalk.com address were being delivered to the server but failed to complete the final leg of their journey to her Gmail account. I checked the server to find those that were stuck and set up an auto-forwarder as a backup, but email her again if she didn’t respond since she doesn’t just ignore emails. Email problems are never-ending and reliability has gone way down with the proliferation of complex setups, spam filters, and black lists.

Was Olive a scam, and if so, who are the victims?

The abrupt shutdown of one-time unicorn Olive have led to declarations that the company was an obvious scam all along. I agree that expectations were inflated with the encouragement of the company’s executives, but I don’t think it meets the definition of “scam” given that savvy customers and private investors voluntarily gave the company money without complaint.

Olive has sold off the remaining pieces of its business for an unreported and likely unimpressive price. Waystar has acquired most of it, but the buyer of  its prior authorization business is Humata Health, which was founded in February 2023, presumably with the specific purpose of buying that business. Humata’s company’s founder is  Jeremy Friese, MD, MBA, who was co-founder and CEO of Verata Health, which Olive acquired in December 2020 to form the business that he is now buying back.

Olive reported annual revenue of $49 million. It had raised $856 million, most recently a July 2021 Series H round with investors Vista Equity Partners, Tiger Global Management, and Base10 Partners that valued the company at $4 billion.

An Axios article quoted former employees and other sources who said that despite calling itself Olive AI, the company was actually using primitive screen-scraping and bot tools that frequently broke when vendors of the EHR and claims software they communicated with changed their systems.

The Axios article questioned the company’s cost savings projections, which rarely materialized. Olive’s sales executives knew that overpromises would still get its foot in the door, where health systems would then reassign employees and make it hard for them to change course and kick Olive out. Olive claimed to have 200 enterprise customers, although Axios reviewed internal documents that showed only 80.

Olive’s KLAS reviews are mostly bad overall, although it scored pretty well in the prior authorization business that it had acquired from Verata. Customers reported some successes, but complained of high executive turnover, lack of focus on customers, and layoffs that caught customers by surprise and reduced the company’s responsiveness. Still, the company featured testimonials from Gundersen, WVU Healthcare, Allegheny Health Network, Renown Health, and others.

I would argue that customers were not scammed. They could have demanded Olive’s full customer list and contacted them before buying. Poor KLAS scores were a lagging indicator, but a big red flag. Customer contracts should have included penalties for failing to hit cost-saving goals.

Public investors weren’t scammed because the company dismantled itself before it could rush an IPO or SPAC merger, which might suggest that the wheels had been coming off for some time. Its reputable, experienced investors had access to internal information that would have revealed warts and all, although the investment environment encouraged big bets of the “greater fool” variety rather than a forensic analysis of whether the company was blowing smoke in claiming to have invented “the Internet of Healthcare” and its ability to “deliver a new healthcare experience for humankind.”

Those who don’t know health IT history and thus are doomed to repeat it should note these lessons:

• Investors, prospects, or a prospective employees need to look beyond the glad-handers and perform due diligence.
• Customers should contractually obligate their vendor to meet whatever results and metric led them to buy in the first place. Cover the items that you need and fear most.
• Companies brag on their use of AI in hopes of commanding a higher valuation as a tech company, as did their late 1990s predecessors in appending .com to their names, but customers shouldn’t care whether a vendor uses AI or an army of offshore workers as long as they receive the expected benefits.
• Sketchy companies generate a lot of hype that is rarely echoed by their actual customers.
• Companies can be wheezing their last even as they pay big money for impressive exhibits and sponsored events at conferences.
• Rapid company expansion, acquisitions that look like an attention-diverting shell game, and a product line that is too confusing to summarize in a single “what does your company do” sentence are reasons for skepticism.
• All companies and investors look smart when the economy is booming.

Webinars

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

Acquisitions, Funding, Business, and Stock

Health Catalyst acquires Electronic Registry Systems, which specializes in cancer registry services and software.

Bain Capital will acquire consulting firm Guidehouse for $5.3 billion from Veritas Capital. Modern Healthcare says that Guidehouse is the second-largest healthcare consulting firm.

Sales

• Accountable Health Partners, a clinically integrated network based in Rochester, NY, selects Health Catalyst’s Data Operating System, enterprise analytics, and professional services.
• NorthShore-Edward-Elmhurst Health (IL) will implement population health software from Lumeris.
• Emory Healthcare (GA) will roll out Andor Health’s ThinkAndor virtual sitter technology, initially piloting it at two hospitals.

People

Direct Recruiters hires Huntsville Magazine owner Christian Byrd, MA (BC Executive Search Firm) as leader of its medical device practice.

Ovation Healthcare names John Mason, MBA (OakHorn Solutions) president of Tempo Technology Services.

Kali Durgampudi, MS (Zelis) joins Apprio as president and CEO of its healthcare automation division.

Announcements and Implementations

Glacial Ridge Health System (MN) will swap out its Healthland EHR for Meditech Expanse on December 1.

Midwestern University Clinics in Illinois and Arizona replace four EHRs with Epic.

A majority of hospitals will turn to outsourcing certain services over the next five years, according to a Black Book poll of management representatives from 1,428 healthcare organizations.

A new KLAS report on data and analytics platforms finds that Dimensional Insight leads the category with an easy-to-use platform that creates digestible metrics that drive outcomes, while Epic and Oracle Health customers struggle with ease of use.

Government and Politics

NSW Health in Australia will spend $640 million to replace nine systems, predominantly Cerner solutions, with Epic over the next 10 years. The decision to make the switch was first announced in 2020 with an initial deployment goal of 2026.

A watchdog agency  reports that the bankrupt Idaho Health Data Exchange spent $92 million in federal funds with little oversight or accountability because the state created it as a private, non-profit corporation.

Privacy and Security

Duke University researchers find that it costs less than $0.50 to buy data about a military service member from a data broker, including their fully identifiable health and financial information. The authors note that the availability of such information could compromise national security and also note that the US lacks privacy regulation that would prohibit the practice elsewhere.

Other

Virginia Mason Franciscan Health launches an enhanced care registered nursing program at St. Anne Hospital (WA), its second this year. The ECRN virtual nursing program was developed to help combat staffing shortages and help prevent burnout. ECRNs joins bedside shift huddles via Zoom and then typically visit patients virtually twice per shift, largely focusing on home medication lists, care plans, and discharge details.

Sponsor Updates

• Consensus Cloud Solutions sponsors Cognosante’s charity golf tournament benefiting Final Salute.
• Southern Endocrinology Associates increases collections by more than 200% using EClinicalWorks and Healow.
• Netsmart showcases advancements driving value-based care success for senior living providers at LeadingAge 2023 through November 8 in Chicago.
• AdvancedMD receives the 2023 ISV Builder Partner of the Year Award from Zoom Video Communications.
• A Geek Leader Podcast features Arrive Health CEO Kyle Kiser.
• Symplr will host a happy hour at the CHIME Fall Forum on Friday, November 10 at the JW Marriott.
• Artera achieves SOC 2 Type 2 compliance for data security, availability, and privacy.
• AvaSure will sponsor the Insights Summit on Virtual Nursing November 15-16 in Washington, DC.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Navigating the healthcare financial landscape in 2024.”
• Bardavon publishes a new injury prevention case study on insurance carriers and brokers, “Reduce Musculoskeletal Claims Volume Using Wearable Technology and Data Analysis.”
• Censinet releases a new Risk Never Sleeps Podcast, “Bridging the Education Gap in War-Torn Ukraine.”
• Current Health will host its US customer summit, This Way Home, November 15-16 in Boston.

Black Book’s top-ranked Q3 2023 managed services vendors include the following HIStalk sponsors:

• Symplr – credentialing and privileging
• Cloudwave – cybersecurity
• Dimensional Insight – data analytics
• Healthcare IT Leaders – ERP support
• Ellkay – integration and interoperability
• Clearwater – privacy, HIPAA, and compliance
• Experity – teleradiology and diagnostic imaging / urgent care
• Tegria – IT outsourcing/partial services

Blog Posts

• Rural Healthcare: Why Advocacy, Community Engagement, and Technology Matter (CereCore)
• Addressing Challenges in Implementing HCC Coding and Risk-Adjusted Coding Programs (AGS Health)
• 3 ways technology has evolved health care (Arcadia)
• Meet the Clinician – Huyen Cam, RRT, RCP (Ascom)
• 10 Questions to Ask When Evaluating Clinical Data Assets (Availity)

Contacts

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

Morning Headlines 11/7/23

Surescripts Acquires ActiveRADAR to Offer Therapeutic Alternatives for Prescriptions

Surescripts acquires ActiveRadar and its Clinical Catalogue of therapeutic alternatives data.

Health Catalyst Acquires ERS, Bolsters Tech-Enabled Managed Services Offering with Data Abstraction and Oncology Registry Management Capabilities

Health Catalyst acquires Electronic Registry Systems, which specializes in cancer registry services and software.

CareCloud Reports Third Quarter 2023 Results

CareCloud expects layoffs, set to wrap up by the end of the year, to help offset a 13% decline in Q3 revenue.

Curbside Consult with Dr. Jayne 11/6/23

Everyone is talking about the recent shutdown of Olive. Looking back over the last several months, HIStalk has been full of mentions of companies that abruptly shut down, declared bankruptcy, or are otherwise in bad shape. Plenty of other healthcare and health-adjacent are companies in those situations, but they don’t always come across our radar or aren’t noteworthy in the healthcare IT realm, so it’s difficult to know what the true number of companies in this situation might be.

In talking with friends who know the industry well, most are in agreement that it’s time for a lot of companies to pay the proverbial piper since they can’t deliver on the promises they made in exchange for startup funding. They forecast that many more companies will be trying to reinvent themselves over the coming months. Those that are successful may live to fight another day, but others may become the stuff of fire sales or ultimately closures.

Taking a look at Olive, some of the problems that they experienced are readily visible at other companies. They promised the use of artificial intelligence and advanced technology, but it was more sizzle than steak as it became apparent that they were using screen scraping tools and less-than-intelligent technologies. In visiting their booth at HIMSS, the team was more excited to talk about their big purple recreational vehicle than it was to talk about their actual solutions. When we did get them to discuss their business, there were plenty of vague ideas, punctuated by delusions of grandiosity. I wasn’t surprised when the company had layoffs in the summer of 2022. CEO Sean Lane explained in an interview, “Our fast-paced growth and lack of focus strained our product and engineering resources and prevented us from executing quickly on key initiatives.”

How many other companies out there are guilty of this? Plenty of startups go after what they perceive is the brightest, shiniest object, throwing their muscle behind initiatives without doing the level of due diligence or project planning that is needed to set themselves up for success. Product and engineering teams often work in a certain degree of chaos, but good people in those disciplines aren’t going to do that indefinitely, especially if other things are going on in the company that make things feel unstable.

I have no knowledge of how those particular teams felt at that particular company, but I’ve consulted for enough startups to have seen some wildly inappropriate leadership behavior that would make anyone vote with their feet. People don’t generally enjoy having projects shelved on a whim, or see funding diverted to initiatives that they know deep down are non-starters. They don’t like CEOS who yell at their teams, micromanage, or have Jekyll and Hyde personality swings. People also tend to be uncomfortable with the idea that their company might be selling vaporware, and are more likely to move on when that starts. One can only pull a rabbit out of the hat so many times before it becomes tiresome.

We know from the postmortem of Theranos that some of these high-flying executives may be lying to their board members and to their investors, as well as to their employees and clients. I haven’t seen any salacious tell-all stories yet about Olive, but will be interested to understand whether there was actual fraud involved or just flagrant mismanagement and a lot of excuses. In this situation, I think there is likely to also have been an element of failure to estimate exactly how much it would cost to try to do artificial intelligence work properly. It’s often much more expensive than people think, especially if you want to do the right kind of training and validation with your models. I’ve seen several companies who claim to have “AI-driven” this or that, when what they really have are sophisticated decision trees and a lot of manual intervention and hard work behind the scenes.

It’s particularly grating when I see a company that is operating in what seems to be a somewhat shady fashion, and I look at their list of investors and see only hospitals and health systems represented. These are their possibly spun-off “innovation” arms, or their venture capital funds rather than the care delivery organizations themselves, but the ultimate source of the money being used for investment is the same – payments from patients, insurance carriers, and the US government. These all boil down to being funded by you and me, in the form of our insurance premiums and tax dollars.

It also makes me angry when I see these care delivery organizations throwing major chunks of cash after technology solutions, when they haven’t yet cleaned up messes of inefficiency that could be handled by solutions they have already purchased. They’re not willing to spend the money to hire analysts and trainers to fully implement the EHRs that they’ve spent tens (if not hundreds) of millions of dollars for, or to optimize those systems to actually improve patient care for the physicians and providers or to improve the patient experience. However, they’re willing to buy other solutions that may just make terrible processes run faster and make their patients and caregivers more frustrated than they already are.

Frankly, you can buy a lot of vaccines, deliver a lot of charity care, and discount a lot of procedures for the hundreds of millions of dollars that are spent annually on solutions that fail to deliver value. Looking at some data on the largest organizations in the most recent year I could find (2021), venture funds run by large hospitals laid out more than $2.7 billion in funding rounds. How much prenatal care could that provide, especially since the US now has the highest infant mortality rate among high-income countries?

They can make the argument that the companies in which they invested are going to bring value that lowers the cost of healthcare, improves outcomes, and more, but the proof is ultimately in the pudding as far as what they are actually able to achieve. I can’t think of anyone I’ve talked to in the last several months that thinks the US healthcare system is stronger or better positioned to handle the challenges it is facing despite all this money being spent on technology. All of the practicing clinicians I speak to are on the frazzled edge, constantly being asked to do more with less, being forced to cut staff, or finding that services have been reduced. Maybe it’s time we start spending healthcare dollars on actual bread-and-butter healthcare delivery and ensure that patients are receiving a minimum level of care before we start writing big checks for pie in the sky ideas.

What do you think about the future of tech unicorns in the healthcare space? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeff Smith, CEO, Bamboo Health

Jeff Smith, MBA, MIB is CEO of Bamboo Health of Louisville, KY.

Tell me about yourself and the company.

I have successfully led multiple startups to market-leading companies that have served payers, pharmacists, and providers. I have found that with a relentless focus on the customer and their needs, you can exceed expectations. While at Lumeris, I led the value-based care enablement business. We worked with health systems and independent physicians to transform their financial and clinical model towards value-based care. That required strategies and tactics that were data-driven, team alignment, and clinical innovation to get to better outcomes in the communities we serve coast to coast. At CVS Health, I led enterprise strategy acquisition, physician connectivity, and population health. I was responsible for working with leaders across the business to develop innovative strategies and translate those into technology-enabled services at the point of care decision-making with the physician office and the pharmacy. That was focused on a scaled, innovative approach across the US for a Fortune 50 business.

Bamboo Health works across the healthcare ecosystem. We have the ability to share what we call critical information through our Smart Signals network. We do that by connecting with more than a billion patient encounters across the United States annually through 2,500 hospitals, 8,000 post-acute facilities, 25,000 pharmacies, 32 health plans, and 50 state governments. It’s a broad reach of the ecosystem, enabling admit-discharge-transfer alerts, bed capacity and availability, insights around where patients can receive care, and valuable prescription drug information down to the point of care as well as at the pharmacy. We do that across more than a million acute and ambulatory providers as well. It’s a broad reach on which we will build our strategy to help individuals across the country.

What has changed since the early days of the pandemic when it quickly became obvious, particularly from a public health standpoint, that our lack of real-time capacity and patient information hampered decision-making?

That’s part of the reason that I joined Bamboo Health. I saw that they had these hundreds of millions of critical moments that were occurring every year at the physician level, point of care, at the hospital admit or discharge, or in the pharmacy. Bamboo’s network has the capacity to be real time. It presents an opportunity for us to branch out from being just a technology company into a technology-enabled services company to connect those individuals, when those critical moments are occurring, to the care they need.

How will drug chains and other retailers fit into a system that has been based around health systems and physician practices?

The value-based care movement is creating companies, or is challenging companies to rethink their strategies as well, as what the end-to-end delivery of care looks like for these individuals. The CVS organization has created  strong vertical integration of everything from insurance all the way to pharmaceutical dispensing and engagement at the filling of those prescriptions. That will present an opportunity and a challenge for many of the existing players to rethink the overall value chain and how they can participate and drive value going forward. 

What’s most critical here is that we keep the patient and what’s best for them in mind and determine how everybody can contribute to the end result of what value-based care is trying to achieve, which is a better experience, a better financial outcome, and overall quality for that patient.

With all these new players requiring clinicians even as more of them quit their professions, how will we shift the design of the system to address clinician scarcity?

The solution is ensuring that people are operating at top of license and that we are efficiently connecting individuals to the care that they need at the right location for the right value for the patient in the system. That will be central to the Bamboo strategy and is seminal for us going forward to be successful as a country and fighting these high cost trends and quality challenges we have.

How will AI contribute?

It will be about information assist versus artificial intelligence actually taking the action. We have started to see here at Bamboo, and I’ve experienced this in other companies, a leapfrog moment for the healthcare delivery system in the United States. The ability to leverage vast amounts of information and be able to create an information assist environment — whether it be for physicians, pharmacists, or even the patient — presents an incredible opportunity for us all to drive greater quality of information that will be presented to all of those different stakeholders, along with an opportunity to create greater efficiency among the system itself and get to the highest value outcomes more quickly.

How do you set a company direction that involves AI when it changes significantly literally every day?

That’s why information assist is the correct framing for the healthcare community versus artificial intelligence that actually takes the action. As we see the future unfolding over the next several years at Bamboo Health, we have these millions of critical health moments occurring. We need to take all of the information that we have through our network and have those manifest themselves in the best next action for the patient. We can turn these seminal moments into an information assist moment for the healthcare providers to help them take that next best action.

We are focused on whole-person care at Bamboo Health. That means prioritizing the entire patient, including behavioral health, in the hundreds of millions of critical moments that occur each year. For example, an elderly woman is brought to the ED by her family after she has ingested a large number of pills. The ED physician will have certain suspicions around what she’s suffering from, such as depression, lack of sleep, or other life pressures. These individuals with severe to moderate mental health or maybe drug addiction issues show up into these points of care, and unfortunately, hospitals don’t have the infrastructure to help them.

The doctor at that moment could create direct access for that patient through what I would call the Bamboo Bridge or maybe some type of easy button, where they would be able to connect that patient to a caregiver in that moment who can serve up information to help them assess that patient. Then imagine that a Bamboo Health care navigator springs into action based on that easy button from the physician, where they can directly assess the patient with the information that we have and that’s provided to us. They can help determine the level of care that is required and then schedule, for example, this woman into a mental health care moment as a follow-up.

We have now been able to efficiently capture a critical moment and connect that physician so they can make a decision based on the information that we either serve up to them or to a Bamboo care navigator who will be more informed because of the information assist that occurs. Now that patient gets connected to the right next step, right next moment of care, and then the physician can feel like the next best action has occurred and that patient is better teed up for their next step with care that’s going to occur. We are getting to a state where we are able to help that patient navigate the system and providing the level of care at each step that is more complete, more informed, and helps that caregiver in the limited time that they have be able to make better decisions on the next best step for that patient.

Many people, especially younger ones, prefer episodic interventions over having an ongoing relationship with a primary care provider who quarterbacks their health needs. Could that next best action concept serve as a technology substitute for an ongoing provider relationship?

Our healthcare system needs to meet the patient where they are. What I’ve seen is that at least around value-based care, you need a quarterback of that care that the patient is attributed to. What’s critical here is that we think about some of these patients in behavioral health, where there’s not enough infrastructure around that primary care provider who has this patient attributed to them. This is something that I think the government is recognizing, that there hasn’t been sufficient reimbursement for physicians who are treating those with depression. They have made some changes to the reimbursement model and ensuring that there are enough dollars to those who are providing care for some of these complex patients that have comorbidities.

To your question, the technology should be part of that infrastructure and providing that information assist for these patients, so that not only are we identifying and engaging, but also helping nudge the patient towards the right actions as they move through their life and through the care delivery system going forward. I see it as complementary, and it likely will be different based on the type of patient and individual that we’re treating.

A healthy individual will have different needs than somebody with behavioral health and the complexities associated with that. The top 5% of patients drive about 50% of healthcare costs. Those patients in that 5%, as we see based on primary and secondary data, have behavioral health issues. These individuals will require more infrastructure and more care, particularly given the comorbidities they have. A patient that has substance use abuse may also have chronic kidney disease. Of those that have chronic kidney disease, one study found that almost 50% have symptoms of depression and anxiety. They also likely have heightened hypertension and diabetes. How are we creating an infrastructure and a care around that patient to engage them based on the different points that they engage in the healthcare community?

Part of our mission at Bamboo is that we want to work with these individuals who have these needs and then take advantage of all these seminal moments, working with our care partners — physicians, pharmacists, the care teams — to best engage that patient along each step of the way. I hope that if we can do that, that technology can nudge them into that next best action. Where I’m particularly excited about is that given the opportunity to engage some of these patients earlier in their disease or as we start to see certain habits emerge, we can more rapidly connect them upstream to these care providers to get them the care that they need. That will help the patient and the families that are trying to get them to a better state down the road.

As a company with private equity backing and an acquisitive history, what are the challenges for younger companies that might be running out of financial runway and opportunities for companies like Bamboo? 

Bamboo is very strong in terms of the current state of the company and our future growth prospects. I feel confident with the involvement of our backers Clearlake Capital and Insight Partners, with $100 billion of capital. Healthcare providers are looking for a turnkey solution to their problems. Bamboo is well positioned, given our customer base and the solution we already have in place, to find partners to supplement what we’re able to do today to create a better turnkey solution for our customers and the patients that we look to serve and exceed their expectations every day.

I came here because of the personal calling that I saw observing the healthcare system and where it is today. We have an opportunity to reduce the suffering that people are experiencing today, like many of us who have had family members and close friends who have struggled with behavioral health. We can make a real difference with the platform we have.