News 12/13/23

Top News

Oracle announces Q2 results: revenue up 5%, adjusted EPS $1.34 versus $1.21, beating earnings expectations but falling short on revenue. CEO Safra Catz said the former Cerner business, acquired for $28 billion in June 2022, produced “a drag on Oracle growth.”

Shares dropped 12% on Tuesday as investors became concerned about the company’s two straight quarters of disappointing cloud revenue.

From the earnings call:

• Total revenue for the quarter grew 4%, but would have increased 6% excluding the contribution of the former Cerner.
• Catz once again mentioned the imperative to “drive Cerner profitability to Oracle standards.” She says that Cerner’s impact on Oracle’s growth will be “sort of negative one to two points” this fiscal year, then it will end.
• Chairman and CTO Larry Ellison says that half of Cerner Millennium customers will move to Oracle Cloud Infrastructure by February. He adds that a rewrite of Millennium will be completed next year and that HealtheIntent is now full SaaS.
  Ellison says that all Millennium applications will be moved to OCI and will switch to subscription pricing.
• He adds that Millennium is being upgraded and modernized “one piece at a time” and will be extended via applications for public health, pharma, and hospital inventory and workforce management as Oracle goes after a bigger piece of the healthcare ecosystem.
• Ellison says in responding to an analyst’s question about generative AI that it can create a patient visit summary from the conversation without using a human scribe, which he says “has shocked a great many people.”

Reader Comments

From Oracool Not: “Re: Oracle. The earnings report is not good news for whatever is left of Cerner.” I said a week ago that it would get ugly if ORCL shares reacted negatively to financial news that could be attributed in any way to the former Cerner business. The CEO’s reaction to Tuesday’s revenue miss was even more direct than I would have expected, where she threw Cerner under the bus for being an underperforming drag on company revenue. Given Wall Street’s quarter-by-quarter fixation and Oracle’s competitive AI and cloud battles with powerhouse tech companies, the obvious answer would seem to be cutting Cerner costs even more, and about the only ways that companies can do that is to reduce headcount, sell real estate, discontinue or sell lower-margin business, and reduce R&D. All of these actions are good for investors and bad for customers.

From Slambob: “Re: Health Gorilla. Co-founder and Chief Strategist Sergio H. Wagner has been relieved of his position and board seat following layoffs of 44% of the workforce and missing two consecutive quarters by more than 80%.” Wagner’s LinkedIn shows that he left the company this month. Health Gorilla was just named as one of the five initial QHINs.

From Banzai Bill: “Re: training doctors. Ask readers how they would shorten the training for primary care doctors.” I’ve asked Dr. Jayne to weigh in and invite physician readers to respond as well. The issues that come to my mind:

• Schools love to collect tuition and the post-graduate donations of physician graduates, but is it really necessary to earn a four-year degree and then attend a four-year medical school before beginning years-long hands-on training?
• Given the speed at which medical knowledge becomes obsolete and how little of it is used by the time a PCP reaches mid-level practice, would it be better to shorten the pre-practice education while moving to continuous learning in a CME-type model?
• Endless amounts of vetted medical data is available electronically and potentially by AI. Is rote memorization of a subset of that same information a waste of time?
• How much could the eight-year classroom time of graduate medical school – before another three or more years of residency – be shortened to create the same outcome?

Webinars

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

Acquisitions, Funding, Business, and Stock

Fruit Street files a $25 million lawsuit against former partner Sharecare, claiming that the company violated the terms of their agreement by launching its own diabetes prevention program rather than continuing to offer Fruit Street’s solution to its members. Both companies offer digital health and wellness programs to employers and payers. Sharecare, meanwhile, contends that Fruit Street owes it $3 million. I had a lot to say – none of it good, but all of it fun reading – about Fruit Street in 2014 and 2021.

Private equity firm KKR opens talks to acquire a 50% stake in healthcare payment and analytics software company Cotiviti from Veritas Capital in a deal that would value the business at between $10 billion and $11 billion. Veritas, which took Cotiviti private in 2018 at a $5 billion valuation, rejected a similar deal from Carlyle Group earlier this year. KKR has invested in such healthcare technology companies as Zeus Health, Clarify Health Solutions, and Therapy Brands.

Data and generative AI company ConcertAI will acquire American Society of Clinical Oncology subsidiary CancerLinQ, which offers real-world oncology data and quality-of-care technology services.

Kaiser Permanente lays off 115 IT employees, 65 of them in Northern California.

Sales

• WellSpan Health (PA) will use Arcadia’s data analytics software to enhance its value-based care efforts.
• Nascentia Health (NY) will implement the Biofourmis Care remote monitoring and care management platform as a part of its new care-at-home programs.

People

Tushar Hazra, PhD (EpitomiOne) joins Parker Health as CTO.

UC San Diego Health names Karandeep Singh, MD (Michigan Medicine) as its first chief health AI officer.

Eagle Telemedicine promotes Jason Povio to CEO. He takes over from Talbot “Mac” McCormick, MD who will take on the role of chief physician executive. CFO Timothy Horton will take on the additional title of EVP.

Impact Advisors hires John Lanari (Nordic) and Kristi Lanciotti, MBA (Optimum Healthcare IT) as VPs.

Howard Landa, MD (Sutter Health) joins Adventist Health as CMIO.

VCU Health hires Jeffrey Kim, MD (Loma Linda University Health) as CMIO.

Announcements and Implementations

Riverwood Healthcare Center (MN) will go live on an OCHIN-hosted Epic system next month.

Phelps Health (MO) begins offering virtual urgent care through KeyCare’s Epic-based technology.

Darena Solutions, Leidos, and SLI Compliance launch a verification process for AI applications that use SMART on FHIR to integrate with EHRs. 

Mitre, the independent trusted third party for the FDA’s voluntary Medical Device Information Analysis and Sharing (MDIAS) program, announces that Atrium Health has signed on as its first health system member.

Government and Politics

ONC and The Sequoia Project officially recognize KONZA National Network, EHealth Exchange, Epic Nexus, Health Gorilla, and MedAllies as QHINs.

A Verato-commissioned survey of 197 executives finds that two-thirds of healthcare organizations aren’t ready to meet Cures Act requirements such as sending electronic patient activity notifications, obtaining consent for sharing data, managing infrastructure for secure information exchange, and sharing patient-level information with patients and other healthcare organizations. Nearly all expect to receive more data requests, and more than half expect patient data-matching to be a major problem.

A congressional investigation finds that chain drug stores are handing over patient records to police and government investigators who present a subpoena rather than a judge-approved warrant. Legal experts raise concerns that chain stores share prescriptions across all locations, creating a national “digital trail” that could be used against patients or pharmacies by states such as Texas, which has threatened to file criminal charges related to the mailing of abortion-inducing drugs to state residents.

Other

London Health Science Centre officials come under fire for spending $50,000 to send 13 IT staff to Oracle Health and Oracle CloudWorld conferences in Las Vegas last September. The Canadian healthcare provider, which is in the midst of a staffing shortage and faces a $76 million deficit, is already under government investigation for spending $470,000 to send staff to conferences in Portugal, Australia, and the UAE.

Sponsor Updates

• Frost & Sullivan recognizes Inovalon’s One real-world data and analytics platform with its 2023 North American Product Leadership Award.
• Agfa HealthCare supports Leeds Teaching Hospitals in the UK in its education initiative.
• CereCore releases a new podcast, “Ways to Overcome the Gap Between IT and Physicians.”
• Consensus Cloud Solutions achieves HITRUST risk-based, two-year recertification.
• Konza names Katy Brown director of marketing.
• EClinicalWorks announces its intent to become a QHIN.

Blog Posts

• Ways to Overcome the Gap Between IT and Physicians (CereCore)
• Leveraging Automation to Manage the No Surprises Act Dispute Process (AGS Health)
• Ripe for automation: How generative AI can enhance patient care (Arcadia)
• Meet the Clinician – Tiffany Kibbee (Ascom)
• A proven approach to reducing patient falls while driving staffing efficiencies (AvaSure)
• 1Clearsense Empowers Healthcare Organizations Across Cloud Environments (Clearsense)
• Active Incident Response Planning: Find It, Fix It, and Go Forward (Clearwater)
• You Can Have Both! How to Maintain Your Cybersecurity Framework While Undergoing Digital Transformation (CTG)
• 5 of the Hottest Digital Health Trends Predicted to Skyrocket in 2024 (Dimensional Insight)
• Reflecting on Progress: A Review of the Healthcare Technology Industry in 2023 (Direct Recruiters)
• Happy Culture, Happy M&A: Strategies for a Successful Cultural Merge (Divurgent)
• 3 Ways to Optimize Your Epic EHR (DrFirst)

Contacts

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

Morning Headlines 12/12/23

ConcertAI to Acquire CancerLinQ to Build the Leading Healthcare Learning and Research Network in Oncology

Data and generative AI company ConcertAI will acquire American Society of Clinical Oncology subsidiary CancerLinQ, which offers real-world oncology data and quality-of-care technology services.

KKR Nears Deal for Cotiviti Valuing Firm at $11 Billion

Private equity firm KKR is in talks to acquire a 50% stake in healthcare payment and analytics software company Cotiviti from Veritas Capital in a deal that would value the business at between $10 billion and $11 billion.

Fruit Street alleges Sharecare cannibalized diabetes product in $25M lawsuit

Fruit Street files a $25 million lawsuit against former partner Sharecare, claiming the company violated the terms of their agreement by launching its own version of Fruit Street’s diabetes management program.

Curbside Consult with Dr. Jayne 12/11/23

I’ve been doing some locum tenens work in a traditional family medicine practice. I can attest that the negative feelings that primary care physicians have towards performing uncompensated work are real.

I was brought in to provide coverage for a physician who is on family leave. I was impressed that the practice would go through the work effort to bring in a locum tenens physician. Many practices just expect the rest of the staff in the practice to absorb the excess work, which often causes resentment when there are partners who take more frequent family leave and others who feel that physicians should “power through.”

That was an interesting dynamic that played out during my interview process with the practice. The partners who were making comments about why they didn’t think my assistance was needed were generally older and/or male, and those who voiced support for having a locum were generally younger and/or female. However, there were some exceptions to the rule.

I hadn’t been told what kind of family leave the physician I’d be filling in for was taking, but was surprised at how willing some of the partners were to share another physician’s private information. One told me, “I worked every day during MY chemo, so I’m not sure why she thinks she needs to be out for her chemo.” On the surface, it’s an unprofessional comment, but it also clued me in to the potential for burnout in this practice since burnout is often associated with lack of empathy.

Another physician told me how glad he was that there would be locum coverage because he was tired of covering his partners because “so many of them have been popping out babies.” He mentioned that he didn’t ever feel the need to take paternity leave and his kids turned out OK. It was good to be clued in about the fact that I would be taking a trip to the cultural 1970s in this wayback machine of a practice, but I agreed to take the job anyway.

Although I have deep experience with the EHR the practice uses, I went through all the onboarding steps, which was good because I got to know the practice’s in-house trainers and super-users well. Fortunately, the practice’s use of technology didn’t mirror their attitudes, and I was impressed by how much delegation and automation they had in place for patients who had medical needs in between their office visits – things like refills, questions about lab tests, etc. Most of those were handled by appropriately trained staff members using standing orders and clinical protocols, which were also built into the EHR for efficiency. I’d give them an A-minus grade for overall efficiency compared to other practices I’ve seen, so I was surprised to hear some of the physicians complaining bitterly about their inboxes.

After getting my feet under me for a bit, I was able to explore what was really going on with patient messages since I was getting a lot of them. It’s been a while since I’ve been in an ambulatory practice during the typical open enrollment period for health insurance, and it turns out that questions about insurance plans, medications, coverage, and the like were making up a high volume of patient questions. Not only were employed patients sending in questions, but plenty of retirees had questions, too, thanks to some recent marketing campaigns on TV that tout the benefits of Medicare Advantage plans. It sounded like many patients were facing dramatic premium hikes and were trying to figure out how to get what they needed in the most economical way possible, but like most patients in the US, they lacked the context to be able to formulate the right questions.

For example, one question was, “Is Cigna better than BCBS for my medicines?” Since this question wasn’t addressed by any of the existing triage protocols, it came to the physician to address. No physician, care coordinator, or health navigator can answer the question with the facts provided. What kind of Cigna or Blue Cross Blue Shield plan are we talking about, HMO, PPO, or something else? Is it a commercial Cigna plan, or one that’s for a self-insured employer that just uses the Cigna network? Are there carve-outs for religious exemptions for employers in this predominantly red state? Is the patient using mail order or retail coverage? Are they stable on their medications or do they have new conditions that are being optimized? Patients were asking their primary care physicians because they felt they had nowhere else to turn to try to figure out what to do for their families.

One of my colleagues mentioned that he saw an article “where someone fed the plan data into AI and then asked it to make comparisons,” but noted that it would be nearly impossible unless you had all the plan details for the various options. Another mentioned that he just tells patients to call their employers and see if they have someone who can help. One noted that he had done that in the past, but found that employers were telling patients to call the office since they didn’t have any idea what the patient’s medicines were to determine the level of coverage. All of this together just goes to illustrate some of the key failings of our healthcare non-system in the US.

The idea that patients should be seen as consumers is part of the problem. Historically, consumer education in the US relies around people being able to make comparisons around price, looking at products with features that they generally understand. It’s one thing to compare the per-ounce price of two brands of pasta sauce, but things get more complicated when you’re trying to compare major appliances like washers. It’s another thing entirely to compare interest rates and mortgage terms to figure out which loan is the best option for a new home purchase. Looking at even more complex consumer comparisons, such as the purchase of an electric versus gas-powered vehicle, it’s different for people to assess because that decision also injects somewhat less-tangible values and feelings about renewable energy, tax policy, and more.

Now, take it to the highest level. Trying to perform comparisons of health insurance coverage is more like graduate-level consumer education. Given the levels of health literacy in the US, it’s no wonder that patients often have little understanding of their coverage.

Recent efforts to make price transparency data available to the public aren’t helpful for the majority of patients. A lot of healthcare is unplanned, and those are the costs that typically push people over the edge. Data from 2022 shows that nearly 40% of people in the US couldn’t cover an unexpected $400 expense. When someone’s child gets bounced off the trampoline and breaks their arm, parents aren’t going to head into the house and price-shop the internet to find the best deals on x-rays and orthopedic consultations. If they’re savvy, they’ll call the number on the back of their insurance card, make sure the emergency visit is authorized, and go to the facility they’re directed to. But a good number of patients are just going to hop in the car and go to the nearest hospital.

At the other end of the spectrum, when you’re diagnosed with a life-changing condition like cancer, what patient has any idea of all the healthcare charges they’re about to get hit with? How are you supposed to shop that around?

For patients with longstanding primary care relationships  — which are becoming fewer in this transactional healthcare landscape that is riddled with third parties trying to pick off the easiest and most profitable patients — these questions roll downhill to the primary care physicians, who are barely better equipped to answer them than the patients themselves. I took the issue to the office manager, who hadn’t previously been made aware of the volume of inquiries the practice was receiving. I’m glad I brought it up because it turns out that the practice’s affiliated health system has volunteers within their patient advocacy department who are tasked with helping answer those questions.

The practice was able to quickly throw together a protocol, including the creation of some quick phrases in the EHR to respond to patient questions and get them headed in the right direction. For those skeptical about having a locum in the practice, I guess I provided a little value-add that day. Now that open enrollment is largely over, those new workflows will be dormant for a while, but it’s nice to know that they’ll be ready for next year. 

As I thought through the whole process, it made me think about the use of AI to make this easier. All of the data needed to make true meaty comparisons lives in the EHR and its corresponding practice management or revenue cycle management system. You have all the medication data, including patient compliance and stability of the treatment regimen. You know what pharmacy the patient uses. You have the data on the different insurance plans such as contracts that at least give an idea about allowable charges and expected adjustments. You also have the data on other physicians the patient sees and their past history.

Certainly some smart people could figure out a way to pull that together along with the data from the insurance plans’ Summary Plan Descriptions, the employer and employee costs, and cost data from the local market. I’d pay money for something like that to help me make the hard decisions and I’m betting I’m not the only one.

What’s the solution to the chaotic problem of choosing your insurance coverage for the year? Is AI the answer? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Interoperability Revolution Continues

The Interoperability Revolution Continues
By Mark Gingrich

Mark Gingrich, MS is chief information officer of Surescripts of Arlington, VA.

Remember when you would leave your doctor’s office with a handwritten paper prescription, and then need to bring it to the local pharmacy to be filled? Hard to believe that was the norm just two decades ago.

The height of innovation was swapping out this piece of paper for an electronic transaction. It was a simple enough concept, but the impacts have turned out to be profound. Electronic prescribing helped revolutionize how care providers and patients shared information, making prescribing safer and faster and connecting prescribers and pharmacists like never before.

Now, 60,000 pharmacies are connected and 2 billion prescriptions were filled using this technology in 2022 alone. E-prescribing serves as the basis for what we now consider healthcare interoperability, but the scale of healthcare interoperability advances every day. Our company, through subsidiary Surescripts Health Information Network LLC, has submitted its application to become a Qualified Health Information Network (QHIN) under the Trusted Exchange Framework and Common Agreement.

But what does healthcare interoperability mean for patients and clinicians? The definition can be something different depending on the stakeholder, yet the definition is far less important than the impact that healthcare interoperability has had and will continue to have in transforming patient care.

The impact is seen when clinicians have the right patient information, such as medication history and clinical documents, at their fingertips, at the right time, and can provide safer, better informed, and less-costly care for their patients. This means stronger, trusted relationships between patients and care providers.

Our company’s master patient index makes it possible for health information for nearly every patient to be accessible by 2 million care providers. Interoperability means connecting 250,000 clinicians across all 50 states and Washington, DC to access 100 million clinical documents each month in 2022, delivering the information they need to care for their patients in the most meaningful way possible. Applying to become a QHIN is the next step towards amplifying our impact in ensuring that care providers can quickly and easily access the information that they need to provide safe, quality, and lower-cost care for their patients.

HIStalk Interviews Nicolas Vanden Abeele, CEO, Ascom

Nicolas Vanden Abeele, MA is CEO of Ascom of Baar, Switzerland.

Tell me about yourself and the company.

I have been the CEO of Ascom for the past two years. Ascom is a Switzerland-based, mid -cap multinational in healthcare technology. All we do is what we call critical communication and collaboration in the healthcare domain, in hospitals and long term care homes and also in enterprise. We are multi-national, in 20-plus countries in the world. The Americas is an important market for us, and definitely Europe and Asia. We span pretty much the three regions around the globe.

We have strong purpose, which is to bring data to lives, with an S. It is all about the lives and the well -being of our patients. By doing so, we want to bring better outcomes. It’s all about, bringing data to life and providing better outcomes. That’s a strong purpose.

It’s about making sure that care delivery is done with the best quality and is as efficient as possible. We improve patient outcomes and patient lives and we enable the caregiver — doctors, nurses, and others in hospitals – to do it as well and as easily as possible.

How will remote patient monitoring develop, both as a technology and as an alternative to in-hospital care?

We enable remote monitoring, which can be in a hospital or care setting or also outside of that, such as monitoring patients at home. We collect patient vitals via medical device integration. We run a number of algorithms within our software platforms to generate outputs, which is data or information that we give to the right caregiver — nurse, doctor, or other  caretaker in a hospital — to take the appropriate actions.

That monitoring can be done in an any hospital setting or care area, such as an emergency department, ICU, operating room, a general ward, or a rehab center. It can also be done at home as an extension of the monitoring in a hospital to a setting outside of that hospital environment to allow a patient to go home earlier. There’s a lot of discussion about earlier discharge, because it’s sometimes better for a patient to be back at home in a more normal setting. It’s also better in terms of recovery, and having these monitoring solutions allows us to also provide the necessary care, even while at home and still under recovery.

We are a key player in what we call critical communication and collaboration. We have mobility solutions, nurse call, and patient assistance solutions. Our software platform aggregates these data and orchestrates a number of actions, outcomes or outputs as information that is sent to the right caregiver, who can take the right action at the right time, even earlier than they would have in a normal situation. It’s all about providing a secure environment to give that right information for the right actions to be taken in time.

Our ambition is to become the the enabling platform to which everything and everyone connects, including sensors, medical devices, and mobility devices. Our ambition and vision is to become that enabling platform in any hospital or care setting.

How have nurse call systems evolved, both from the patient’s point of view as well as the routing of messages?

We have our nurse call and patient system, and then we have our software platform that is the orchestration behind that. Our Ascom Healthcare Platform orchestrates by using the right patient data to trigger the right outcomes. These right outcomes are alarms, alerts, and basic data sent to the right caregiver. If that caregiver is not available because they are treating another patient, the information is sent to other caregivers to make sure that that the appropriate care is given within the appropriate time.

We are speaking about lives of patients. We are speaking about patient safety and patient quality. Our systems are robust and ensure that the caregiver is informed in time of any event or issue. It could be replacing an insulin pump, but it could also be a more serious issue.

These systems operate in a medical environment, so they must apply filtering to extract the right information from all of the noise and information that is circulating. They capture the right data points and trigger the right actions to the right caregiver with an escalation procedure, so that if that caregiver is not available, it’s then immediately sent to the next one available to make sure that within a short timeframe, the right action is taken to serve the patient.

We need to ensure that level of quality, and to avoid being viewed as a system that is interruptive, integrating the technology well into the workflow of the people who receive those messages.  We have quite a number of workflows for medical device integration, alarm management, smart alarm filtering, and clinical monitoring in a hospital setting. It’s also in all of the different care areas — emergency department, operating room, ICU, general ward, rehab center, then also to outpatient rehab centers, dialysis centers, and even the patient at home.

On that latter, there’s a lot of discussion going on about the hospital at home. It is definitely something that is increasing and will increase further going forward. Hospitals are under certain financial pressures. It’s better for the patient. It’s also clinically proven that for certain recovery, it’s better to be in a more relaxed home environment. That’s where the monitoring solution provides the care in monitoring of the patient at home.

How is technology being used to help with care coordination in going beyond simple messaging to exchanging of media and content, where one clinician shares what they are seeing with another clinician who is located elsewhere?

We want to ensure that information is made available to the caregiver at the right time in order for them to able to deliver care more easily and efficiently. We have a shortage of thousands of nurses in the US, and that is expected to increase in the near future. You need to deliver different types of workflow solutions to make sure that you can provide it as efficiently as possible.

Secondly, the aging of the population will put additional demands, and I would say additional strains, on the healthcare sector. Over the next 20 to 30 years, we will need to rethink the way that care is being delivered and to leverage all potential digital tools to make care delivery as efficient and as easy as possible. For example, a nurse today walks an average of 12 or 13 kilometers each day doing their job, going to patient rooms. With the systems and the tools that we provide, we can reduce that to seven or eight kilometers. That is still a lot since they still have to move from one room or one department to another, but it’s a significant reduction in distance walked, time, and the quality of the job that a nurse can provide.

We have deployed, in a number of our customer hospitals in the US, a virtual nurse solution. We complement the nurse who is rounding with assistance from specialist nurses in certain care areas or certain care domains.

These are examples of making care delivery better for the patient, but also easier and better for the caregiver given the nurse shortages and increased demand on the healthcare system. This is of growing importance given the demographics and trend. We’re on a good path to position our footprint in many the hospital networks in the US.

Is that virtual nurse back-up different from health systems that have created 24×7 virtual nurse centers?

We do remote monitoring and clinical surveillance, which can be within a hospital setting or remote when the patient is at home. But the one I was referring to in terms of virtual nurse is a novel concept, something that we see as necessary in many hospital settings in the US to complement the level of expertise. It’s an additional pair of eyes or hand for the nurse to call in specialist advice. We see a good traction and demand in the market for that.

Could that virtual nurse concept extend across care settings, such as a nurse in a skilled nursing facility who has backup from a specialized hospital nurse?

Yes. Long -term care home settings use similar workflows as in a hospital, and we offer those. Obviously it’s sometimes less complex than in a more critical hospital environment. But the virtual nurse concept, the monitoring concept, can be within the care home setting. That allows more privacy and less disturbance of the residents since the nurse doesn’t have to go in every half an hour to have a look.  They can leave the resident in their room or apartment in the care home setting.

We can do a number of things there as well. For example, our SmartSense solution has sensors that can perform movement detection in the room. That could prevent falls if the patient is moving a lot, for example. But we can also look at patterns. If the patient normally has a good night and sleeps seven, eight, or 10 hours and all of a sudden that pattern is disturbed and they wake up four or five times a night, that’s unusual. Even with the best nurses, you might don’t notice. The system can help monitor these things and then preventively say that something seems to be happening here. If the patient normally is up at 7 or 8 a.m. and a couple of days they wake up at 9 or 10 or spend 20 minutes in the bathroom, it triggers an alarm automatically.

We can parameterize certain habits of patients to provide better care. We also do monitoring of patients in long-term care homes, elderly patients. For Alzheimer’s patients, you also need to monitor movement and give them access rights for certain areas of that care home. You can block doors or block access to certain departments so the patient doesn’t get lost and to make sure that you have a secure environment where they can move around. We offer quite a number of very interesting workflows across the different domains of long -term care homes or hospitals.

What are the company’s priorities over the next three or four years?

We are a global company. We want to become that enabling platform in a care setting and hospital, a platform to which everything and everyone connects, and to provide these workflow solutions to deliver better patient outcomes and also better outcomes for the caregivers. We are an innovative company, so we are continuously innovating and enhancing our solutions to provide more value and a better return on investment for our customers.That’s what we do every day, and that’s what we want to continue doing in the future.

We are a company with a strong purpose, bringing data to life and delivering better outcomes. That’s all we do. We are an innovative company with with significant growth ambitions, and we are on a very nice growth track in a very interesting industry.

Morning Headlines 12/11/23

Veradigm Inc. Announces Leadership Transition

The board of Veradigm fires the company’s CEO and CFO for failing to comply with financial reporting and disclosure policies, following an investigation by its audit committee.

Hundreds of patients receive threatening emails after Fred Hutch cyberattack

Hackers email Fred Hutchinson Cancer Center patients demanding payment to prevent their information from being sold.

Ransomware group posts stolen Tri-City Center documents to dark web

Cyberextortionists post a “proof pack” of patient information that they obtained from Tri-City Medical Center (CA) following a ransomware attack that took its systems offline for more than two weeks.

Monday Morning Update 12/11/23

Top News

The board of Veradigm fires the company’s CEO and CFO for failing to comply with financial reporting and disclosure policies, following an investigation by its audit committee. Veradigm hasn’t filed financial reports for a year due to accounting software problems, which caused Nasdaq to repeatedly warn the company about the potential de-listing of MDRX shares.

The terminated executives are Richard Poulton, CEO, who also resigned from the company’s board, and Leah Jones, CFO. The company has named interim executives and has launched a search for their permanent replacements.

MDRX shares dropped 20% on the news Friday. They are down 46% in the past 12 months versus the S&P 500’s 16% gain, valuing the company at $1.1 billion.

Interim CEO Shih-Yin Ho, MD, MBA and interim CFO Leland Westerfield, who are both members of the company’s board, will be paid up to $770,000 and $1 million, respectively, for six months, with the option to extend the agreement. That includes $200,000 for each executive that is contingent on hiring their permanent replacements and filing the overdue SEC financial reports.

Severance for Poulton and Jones will total $2.1 million and $200,000 with accelerated share vesting, respectively, and Jones will provide consulting services for six months for $360,000.

Nasdaq has not announced the results of its November 16 hearing in which the de-listing of Veradigm’s shares was to have been decided.

Reader Comments

From Re-Joyce: “Re: R1 RCM. Quite a turnaround from its days as Accretive Health.” Accretive’s history is spotty – it had to settle FTC charges of poor data security, was banned from doing business in Minnesota for positioning bonus-incented debt collectors inside hospitals to press ED and breast cancer patients for payment while they waited to be seen, and had shares de-listed from NYSE for missing filings. The company renamed itself to R1 RCM in 2017 after getting a $200 million investment from Ascension and an investment firm and went public in March 2018. Shares have lost 60% since their highs in early 2021.

HIStalk Announcements and Requests

Health IT conferences are a long way from earning an A grade from poll respondents for their presenter diversity.

New poll to your right or here: Has your resume ever included a paid-for award or vanity article? (should membership in Chief count?). Many years ago, I was annoyed at the proliferation of diploma mill degrees being claimed by healthcare folks and ran links to their LinkedIn on HIStalk, which earned me some nasty letters and threats. Interestingly, those people left their phony credentials intact, apparently convinced that their deceit would remain undetected if I didn’t call it out.

I’ve read several health IT “interviews” lately that quoted the subject as magically speaking in bullet lists and parenthetical asides, clearly indicating that the interviewee was responding to questions in writing and probably with the help of a PR team. I don’t give interviewees my questions in advance (because that’s not an actual conversation) and I don’t allow pre-publication review or editing. Interviewees have to trust me and be confident that they can answer without help, but the end result is far more interesting.

My solution for Dr. Jayne’s “one space or two after a period” dilemma is to write like the imitative self-promoters on LinkedIn who waste reader time and patience by making each sentence its own paragraph in their attempt to seem patiently profound (not really — I move on quickly in assuming that a lot of white space in “content” means a lot of white space in the author’s thinking). I will also note that while Dr. Jayne is stricken with existential Gen X angst about unlearning now-illogical habits that she developed while using a machine that has been obsolete for 40 years, she can take comfort that Word removes the extra spaces, so they never showed up in her HIStalk posts anyway. Now do indented first paragraph lines.

John sent me a Donors Choose donation that, with matching funds, provided Mr. C’s middle school class in Pennsylvania with biology and physics hands-on activities.

I was snooping around the HIMSS conference website and noticed that HIMSS27 is now set for Chicago after two years in Las Vegas, so HIMSS24 will be the last stop in Orlando for a while. Exhibitor count is at 514 and most booths are showing as unavailable except the 10x10s that go for $6,000.

Webinars

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

Acquisitions, Funding, Business, and Stock

Mail order teeth straightening device “teledentistry” vendor SmileDirectClub shuts down, telling customers that they won’t get the treatments remaining in their two-year, $2,000 program (but still have to pay their balance). The company went public in September 2019 at a valuation of $9 billion, with shares tanking 27% on their first day of trading. The company made its two 30-year-old founders billionaires, never turned a profit, and amassed nearly $1 billion in debt before it filed Chapter 11 bankruptcy in late September and then failed to find a buyer. The founders, whose previous business experience involved running a car detailing service, were financially backed by two private equity fund operators, the father and uncle of one of the founders (the three are pictured above). The father held shares that were worth billions, at least for a short time.

Cigna ends its attempts to acquire insurance rival Humana when the companies fail to agree on a price. Cigna will instead buy back $10 billion of its shares, which the company says are “significantly undervalued,” and will seek bolt-on acquisitions.

People

Clarify Health Solutions promotes Terry Boch to CEO. She replaces founder Jean Druin, MD, who will remain on the board.

Privacy and Security

Cyberextortionists post a “proof pack” of patient information that they obtained from Tri-City Medical Center (CA) following a ransomware attack that took its systems offline for more than two weeks. Such groups often call patients whose information they’ve stolen to suggest that they urge hospital leaders to pay the ransom to avoid public release.

In a similar event, patients of Fred Hutchinson Cancer Center are being emailed by hackers who demand payment of $50 to prevent their information from being sold.

Other

The New York Times reports that Bellevue Hospital (NY) is using aggressive marketing techniques and per-procedure surgeon incentive payments to create a bariatric surgery factory in which patients are scheduled for the OR after a single quick visit and little understanding of the risks involved. Some of the patients it recruited are prisoners who lave little chance of following the required post-surgery diet. The hospital is paid at least $11,000 for each surgery, sometimes much more, and expects to do 3,000 cases at an estimated revenue of $34 million. The Times says that the weight loss surgeries often get OR priority over patients with stab wounds and detached fingers.

Sponsor Updates

• Netsmart employees sort food donations at the Manna Food Bank in Asheville, NC.
• Pivot Point Consulting Senior Director Jim Hogan attains CDHE certification from CHIME in digital health.
• QGenda will exhibit at PGA 2023 in New York City through December 11.
• AdvancedMD earns its Electronic Prescribing for Controlled Substances recertification from the Drummond Group.
• Rhapsody publishes a new guide, “How to Reinvent Interoperability.”

Blog Posts

• Culture still eats strategy for breakfast: Insight from our roundtable discussion (NTT Data)
• Intelligent patient experiences, part 5: How strategic is your patient engagement strategy? (Nuance)
• Nurses of Note 2023: The Lead Director for Ambulatory Care Management (PerfectServe)
• A Year in Review: 2023 Trends and Challenges in Healthcare with a Glimpse of What’s to Come (Vyne Medical)
• Gig Economy: Where 9-to-5 is So Last Century (Revuud)
• How Patients Stay Well at StayWell Pharmacy (Surescripts)
• Overcoming Healthcare Staffing Challenges in 2024 (Symplr)
• Interview: Jennifer’s Journey of Caregiving for her Mother (Trualta)

Contacts

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

Morning Headlines 12/8/23

Novant to move some IT operations to Indian vendor. System declines to say how many employees will be affected

Novant Health (NC) will outsource some of its IT department’s work to India-based Wipro.

St. Francis systems restored after ransomware attack

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

HHS’ Office for Civil Rights Settles First Ever Phishing Cyber-Attack Investigation

Lafourche Medical Group (LA) will pay HHS OCR $480,000 to settle potential HIPAA violations related to a 2021 phishing attack that exposed the PHI of 35,000 people.

News 12/8/23

Top News

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

I found this SnapCare explainer video on YouTube.

Webinars

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

Acquisitions, Funding, Business, and Stock

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

People

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

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

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

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

Announcements and Implementations

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

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

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

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

Privacy and Security

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

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

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 12/7/23

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 12/7/23

R1 RCM to Acquire Acclara

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

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

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

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

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

Healthcare AI News 12/6/23

News

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

Business

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

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

Research

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

Other

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

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

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

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

Contacts

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

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

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

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

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

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

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

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

My five biggest takeaways include:

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

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

Morning Headlines 12/6/23

CVS To Rebrand Growing Health Services As ‘CVS Healthspire’

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

Tower Health laid off 30 people on Tuesday

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

Army veteran files lawsuit alleging VA computer system delayed cancer diagnosis

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

News 12/6/23

Top News

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

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

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

Reader Comments

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

People

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

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

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

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

Announcements and Implementations

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

Government and Politics

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

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

Privacy and Security

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 12/5/23

Gemspring Capital Announces Sale of Valant

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

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

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

Notice of information security incident involving Fred Hutchinson Cancer Center

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

Curbside Consult with Dr. Jayne 12/4/23

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.