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HIStalk Interviews Robbie Hughes, CEO, Lumeon

December 2, 2020 Interviews No Comments

Robbie Hughes, MEng is founder and CEO of Lumeon of Boston, MA.

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Tell me about yourself and the company.

I’m an aerospace engineer. I’ve been a computer geek all my life. I was particularly interested in the problem of the computerization of industries versus the digitization of industries. That led me when I was still a student into the law, accountancy, and healthcare. All of those industries were activity-based in their reimbursement forms, and all I saw was using computers as expensive typewriters rather than the way I’d been brought up to use them.

Characterize me as a computer geek who was naive enough to think I could get rid of variability in healthcare delivery and stubborn enough to stick at it for now 15 years. But the thing that interests me, and the thing that got me into this in the first place, was, how do you deliver a common standard of care across a network? That’s the variability problem I’ve been going after all this time.

Lumeon is an agility layer that sits on top of the EHR. It helps providers personalize and operationalize a common standard of care across the enterprise. The people who buy that tend to be interested in doing something different, innovating around an operating model, innovating around a new way of delivering care. That lends itself in particular to risk-bearing entities who want to principally use automation to cut out costs and transform care. That’s a lens that we bring to it.

We started in Europe. We moved over to the US, and obviously there’s a huge amount of difference between those two environments. But there’s also a huge amount that is similar, so we’ve been lucky to be able to isolate a lot of what’s common between the two and bring it from one environment to another in a relatively interesting and different way.

Are providers interested in standardizing care when their patient population is a mix of fee-for-service and value-based care?

Absolutely yes, but we need to be really careful about the language. What we don’t do is standardized care. What we do do is standardize decision-making that results in the personalization of care. So the problem as I see it is not how to do the same thing to every patient, it’s how to apply a common standard or apply the same decisions in the same way to every patient. That results in the appropriate application of the right care to the right patient, which in a fee-for-service construct, very happily is usually reimbursed.

The effect we tend to see is not only in elimination of waste — which is good in both environments — but also an increase in throughput, which tends to increase reimbursement and revenue as well. We’re in the slightly strange position of being able to drive up revenue in a fee-for-service environment as well as cut costs in both the capitated or risk-sharing environment.

That’s the core of what we do. It’s basically ensuring that every case, every patient gets the right care, and because the fee-for-service model reimburses the right activities, generally speaking, you will find the reimbursement goes up.

Is it hard to get enough information from the EHR to allow you to provide the best recommendations for all patients?

It’s very difficult. The way we do it is what we think is a little bit easier. I’ve been doing this long enough to know that you don’t try to eat the whole elephant in one go. When we started out, we would go off and do 100-site enterprise deployments that would take two or three years to roll out. Whilst that was, let’s call it educational, I wouldn’t describe it necessarily as fun.

The approach we’ve taken instead is to try to think about what is a digestible version of that problem that can be applied quickly and that can deliver value quickly for the customer, so that you never actually need to solve the problem of, what is the entire universe of care for every patient and every possibility? I don’t believe today that’s a tractable problem. Instead, what we tend to focus on is identify processes where there are gaps or discontinuities or grit in the machine, if you like. Then, how do you apply automation to that to deliver that lift, that personalization, but also that control and predictability to ensure that you are operating at peak performance?

You’ll know that the typical areas that you’ll find this will be around care transitions. For example, that will be around surgery and obviously in population health, where you’re trying to get large populations to do specific things, but each one of those things need to be specific to the individual. Those are the kinds of areas that we tend to specialize and see the most benefit.

Analytics-powered population health was mostly an aspirational legacy software vendor’s overused marketing term a handful of years ago. Has the definition or the expectation around PHM changed?

This was one of the really curious things to me when I came to the US a few years back. I looked at population health management as a category, and I thought, that’s interesting. That should be the application of the appropriate care to the individual at population scale. That’s what we do.

But the reality of the market seemed to be somewhat limited to meeting your quality measure obligations, and most specifically, looking at population health as an analytics and insight problem rather than an action problem. Population health management as a noun rather than a verb.

For us, the analytics are interesting. They tell you where to point the machine, but the problem we’re interested in is, how do you actually operationalize that? How do you solve that last-mile problem so you can drive the engagement, drive the personalization? Anyone can do the analytics with enough horsepower, but actually driving real change in a health system so that you are appropriately intervening with the appropriate patients with the appropriate care at the appropriate time — that’s a hard and interesting problem. That’s the thing that gets us up every morning.

The pandemic has possibly set us back, where we’ve moved to video visits that may be disconnected from the the patient’s usual providers and interrupting their normal health maintenance activities. Has care coordination suffered, or has the pandemic done us a favor to show us what we need to change?

Telehealth is probably the most interesting version of this care coordination problem. Health systems have lurched towards swapping face-to-face visits with video visits, which is a fine and a reasonable thing to do. But what nobody’s really thought about, or at least nobody that I can see has really thought about, is the governance around this.

When is it appropriate to have a telehealth visit that is provided virtually rather than a visit that’s done face-to-face? When is it safe to do so? What are the benefits? What is the standard of care that might be reasonably considered in a remote or in a face-to-face environment, how are they different, and what do you need to do differently?

For me, the orchestration of virtual care and the safety netting of it through the use of a combination of remote patient monitoring, screening, or any number of the other myriad interventions that exist for us today is the ultimate care coordination problem. It isn’t just now a problem of, “this patient is due for their flu shot” or “this patient is overdue for their colonoscopy.” This is now a problem of, for this patient and their presentation, that the next thing that they need to do is share this information, because it’s missing in their medical record. That will then tell us whether they can have the bit after that in this form or the other, et cetera, et cetera.

This orchestration of the fragments of care delivery is going to get dialed up to 11 if we are serious about using… I’m going to use the term virtual care, because I believe that’s different from telehealth in a meaningful way. I think that’s what the consumer wants. The consumer wants something that looks like every other industry, but there is a safety and a governance aspect to the application of these types of interventions in our industry that has not yet been, shall we say, road tested in any meaningful way.

I’ll bet there’s going to be a ton of lawsuits, not just in the US, but globally, next year from patients who have been misdiagnosed, mistreated, or forgotten about because of this very problem. When the dust settles from all of COVID, I think this is going to be one of the more interesting problems for the industry to address.

Much of the value in a visit is simply asking the patient how they are doing and using their answer to guide the next steps. Are we overlooking the value of allowing the individual to electronically document and contribute their own sense of wellbeing, activity level, or concerns?

One of the overlooked aspects of automation is that it should, if done well, enable hyper-personalization. For me, automation is not, at least not in our industry, about doing the same thing for every patient. It’s about looking at the marginal cost of every single activity and trying to reduce that to zero so that you can implement as many different activities as you possibly can to build up the most robust picture and then use that to drive the appropriate intervention.

In your example, I would advocate that the face-to-face consultation could be augmented by tele-triage in advance, whether asynchronously or synchronously, to determine the best use of the face-to-face time that that physician or clinician will have with the patient. It’s a perfectly reasonable thing to do. But in the case that it’s not face-to-face, you could apply the same model, but you can also look at other things.

If the consultation is face-to-face, for example, perhaps the patient has a sweaty palm, and as they’re leaving the consultation, they shake the hand of the physician and say, “Oh, just one more thing, Doctor.” That’s a classic pattern that, in a face-to-face environment, a physician would tend to leverage to gain better insight. But in a remote consultation, they can see that the paint is peeling off the walls, that they don’t have a chair to sit on, that they have 13 cats on the sofa, and there are people shouting in the background. You can build up a picture of the patient that is — I don’t want to say more complete or less complete, but suddenly different. The cues and signals that you look for in these environments are going to be different.

Again, not to say that either of these is right or wrong, but the important thing to realize is the expectation and the baseline that we set for care delivery in the “old normal” is completely different to what we might anticipate in the “new normal,” and we need to adjust. We need to design our interventions appropriately, and we need to recognize that the patterns, cues, behaviors, checklists, or whatever that we had previously are no longer going to be as useful. That’s a huge, huge opportunity if it’s embraced. 

Again, this is kind of why I got into this. The trick is, how do you bring it together? How do you orchestrate it with precision? Because there is such a thing as the objectively right care for a given patient. It’s just that in this industry we tend to apply a lot more subjectivity to that than perhaps I think we should.

Will hospitals and practices whose capacity is once again being challenged by the pandemic respond by using those technologies that were rushed into service in the spring – such as telehealth and contact-free check-in – or will we see another wave of innovation?

We first need to come to a common understanding about what the core problem that we’re solving, and I don’t know that the industry has necessarily done that yet. People have applied the solution at hand to the symptoms that they see, but there is another level of optimization that needs to take place to create the sustainability and to create from scalability of even those same solutions and those same interventions before we get to another round of innovation. There’s a lot that can and will be done, but we have a lot to fix on the ground first. I’m not convinced necessarily that there is a universal view in the industry about what “good” looks like.

I would say that there’s the reimbursement problem which needs to be addressed one way or another, and obviously that’s going to drive a lot of behavior. Consumer expectations are being set. I think there’s going to be a lot of conflicting opinions around the level of reimbursement anticipated because the standard of care will be different. I think that’s an entirely reasonable debate, but I would advocate for much more freedom in terms of how people think about reimbursement, particularly around service lines and particular outcomes.

A lot of simplification can happen that will create innovation. I see a lot of complexity being introduced in order to manage some of the risks and bridge to transition. Whereas if you look to other industries like the cosmetic surgery industry, it’s well published that cosmetic surgery and the cosmetics industry more broadly has been publishing a fixed price for a long time. Costs have been driven down there in an environment that is broadly similar to many other surgical interventions in healthcare. If we can get to a place where there is predictable pricing for predictable care, that will unleash a huge amount of innovation, and we will see a lot of adoption of all kinds of both operating models and technology potentially to support them. But everything begins and ends with money, so I would advocate for that kind of approach. I think if we do that, we will see the kind of movement we all want to see.

What changes do you expect to see with the company over the next three to five years?

The core emphasis of the company is on the US market. The core things that matter to us are around being aligned with our customers. I got into this because we have a very firm belief that it is possible to both take costs out of care and to improve the quality of care being delivered, however you define quality. Every time we’ve done this, the quality comes alongside cost reduction. I’ve yet to see a single example, over my many years of doing this, where the cost has increased and the quality has gone up. It has always been that the cost has gone down and quality has gone up.

That’s our North Star. The one thing we do, the one thing that drives us, is, how do we improve the quality and the consistency of what our customers deliver? Nothing else matters, really. If we do that, then our customers will speak for us. If our customers speak for us, then we will have commercial success, and we will create the flywheel that everyone wants.

But the healthcare industry is not one single, homogenous market. It is extremely diverse, extremely amorphous in payment model, operating model, structure, patient population, et cetera. It would be naive to suggest that one approach will work for each different environment. The customer intimacy that comes from the analysis we do, from the deployment work we do, from that strive for quality, is what makes us different and is what allows us to adjust for that. But I wouldn’t necessarily say that it’s a straight line path to success.

Anyone who gets into this industry who is trying to do anything, let alone any of the problems we’ve decided to solve for, is going to be in it for the long haul. But it’s nothing more than singular focus on that one thing, driving for quality and taking out waste. I think if we continue to do that in the way that we’re doing, we’ll all be successful, no matter what happens in the broader market.

Do you have any final thoughts?

It’s a fascinating time to be in this industry, and it’s a privilege to be able to work with some of the people we do. If I was to go back and give my 23-year-old self some advice, it would be to pick an easier problem to solve than trying to get rid of the biggest problem in the biggest industry in a country 3,000 miles away from where you’re based. But it is an absolute privilege to be able to do what I do, and if it didn’t work, I wouldn’t still be doing it. I’m grateful for the opportunity to talk to you and hope to be doing it for many years more.

Morning Headlines 12/2/20

December 1, 2020 Headlines No Comments

Say “Hey!” to Project US@ – a Unified Specification for Address in Health Care

ONC, HL7, and other participants announce Project US@, which hopes to publish a healthcare standard for representing patient addresses sometime next year.

Olive Attracts Additional $225.5MM Investment to Fast-Track AI Workforce For Healthcare

Healthcare process automation vendor Olive achieves a $1.5 billion valuation after announcing a $225 million financing round.

Salesforce acquires Slack for over $27 billion, marking cloud software vendor’s largest deal ever

Salesforce acquires Slack for $27.7 billion.

DAS Health Acquires Randall Technology Services

Ambulatory health IT company Das Health Ventures acquires Randall Technology Services and its portfolio of Allscripts EHR and practice management solutions.

News 12/2/20

December 1, 2020 News 2 Comments

Top News

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ONC, HL7, and other participants announce Project US@, which hopes to publish a healthcare standard for representing patient addresses sometime next year.

The project will review the US Postal Service Postal Addressing Standards, but says those can’t be adopted directly because they include both “preferred” and “acceptable” spellings and abbreviations and also require manual reconciliation with reference files.


HIStalk Announcements and Requests

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No, Politico, Vice-President Pence did not say that the “calvary” was coming, unless he was referencing religion or geography and you forgot to capitalize.


Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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


Acquisitions, Funding, Business, and Stock

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Virtual healthcare collaboration and delivery company Andor Health announces a Series A funding round from Microsoft’s M12 venture fund. CEO Raj Toleti’s health IT leadership experience includes stints at early patient kiosk company Galvanon (acquired by NCR), PatientPoint, and HealthGrid, which he co-founded and later sold to Allscripts.

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Workforce solutions company HealthStream acquires Change Healthcare’s capacity management business, including its Ansos staff scheduling software, for $67.5 million in cash. Ninety Change employees will join HealthStream’s Workforce Solutions business, which includes its previous acquisitions ShiftWizard and NurseGrid.

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Healthcare process automation vendor Olive achieves a $1.5 billion valuation after announcing a $225 million financing round.

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Salesforce acquires Slack for $27.7 billion. 


Sales

  • Med Smart Wellness Centers will implement EHR and billing software from AdvancedMD at its first facility in Aventura, FL.

People

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Spok names Kristen Lalowski, RN (MDLive) chief product officer.

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Cheryl Pegus, MD (Cambia Health Solutions) will join Walmart as EVP of health and wellness.

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Apervita hires David Yakimischak (ConnectiveRx) as CTO.

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Eric Nilsson (The SSI Group) joins Medstreaming as CTO.


Announcements and Implementations

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Agfa Healthcare announces GA of Rubee for AI, specialty-specific AI software for enterprise imaging.

The Vascular Institute of Chattanooga (TN) implements Saykara’s voice-enabled, mobile AI assistant for clinical charting.


COVID-19

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A record 96,039 Americans were in the hospital with COVID-19 on Monday even as “data wobbles” that were caused by delayed reporting over Thanksgiving and the weekend will likely cause a spike in testing, case, and death counts during this week’s data submission catch-up. Total US COVID-19 deaths are at 269,000. Experts are questioning whether the decrease in week-ago new cases versus new hospitalizations as a percentage means that hospitals are sending people home who would have been sick enough to admit before beds became scarce.

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Controversial White House coronavirus advisor and radiologist Scott Atlas, MD resigns his temporary position after four months, declaring in his resignation letter that his entire focus was to save lives using the latest science and evidence without political consideration. 

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A CDC advisory committee met Tuesday afternoon to determine which groups will be the first to receive a coronavirus vaccine. Meanwhile, analysis of 534,000 COVID-19 Medicare claims finds that the most significant risk factors for over-65 coronavirus deaths are advanced age (over 85 years of age), male sex, and non-white race. Leading comorbidities are sickle cell disease, chronic kidney disease, leukemias and lymphomas, heart failure, and diabetes. Authors of the pre-print research suggest that CDC consider these factors in its prioritization.

CDC will reportedly reduce its recommended 10-day isolation period for people with known COVID-19 infection to five days, reflecting new analysis that suggests that most spread occurs from two days before symptom onset to five days after. The reduced isolation would make it more likely that infected people will comply.

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Carnegie Mellon University’s Delphi Research Group enhances its COVIDcast real-time, community-level COVID-19 indicators with de-identified claims data from Change Healthcare.

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A CDC analysis finds that COVID-19 hospital information from the HHS Protect system sharply diverges from other hospital data sources that are used by many states, potentially giving government health officials and hospital personnel inaccurate estimates of disease burden and resource availability. One official has said HHS data is of poor quality, inconsistent with state reports, and presented with slipshod analysis. Responsibility for COVID-19 hospital data was abruptly transitioned from the CDC to HHS in July, with data collection handled by TeleTracking and database management by Palantir. 


Other

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Alphabet’s DeepMind says it has developed an AI system that has solved the “protein folding problem” decades ahead of expectations, which will allow faster drug development and use of existing drugs to treat new viruses and diseases. The company has not said how it will share its findings.

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The Association of Health Care Journalists calls HIMSS an “industry trade group,” which made me recall the quick correction that HIMSS issued years ago when I called out that its own press released identified it as such (correctly, I would argue) for the first time.


Sponsor Updates

  • Bluetree hires Christal Kozloski to direct its new Payer Solutions portfolio.
  • Frost & Sullivan recognizes Change Healthcare with its 2020 North American Cloud-Based Enterprise Imaging Customer Value Leadership Award.
  • CI Security will exhibit at the Atlanta Virtual Cybersecurity Summit December 2-3.
  • Digital.com includes AdvancedMD, Cerner, and EClinicalWorks among the best medical billing companies of 2020.
  • Diameter Health will host its second annual customer forum virtually December 3-4.
  • Engage publishes a new case study, “Engage’s ‘Army of Experts’ Provides Integrated Hosting and Consulting Services for Meditech Implementation at San Luis Valley Health.”
  • Lumeon makes its patient appointment reminders, and virtual care and telehealth solutions available in the Epic App Orchard.
  • The EverCare Group implements Wolters Kluwer Health’s UpToDate Advanced clinical decision support software at its hospitals in Africa and India.
  • Summit Healthcare expands its integration partnership with EMPI vendor NextGate to include real-time patient identification across its network of hospital systems.

Blog Posts


Contacts

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

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Morning Headlines 12/1/20

November 30, 2020 Headlines No Comments

Skylight Health Announces Rebrand and Corporate Plan to Provide Primary Care Nationally to Millions of Americans

Clinic operator and health IT developer CBS Insights rebrands to Skylight Health Group.

M12 Invests in the Future of Virtual Health with Andor Health

Virtual healthcare collaboration and delivery company Andor Health announces a Series A funding round from Microsoft’s M12 venture fund.

Change Healthcare Announces Sale of Capacity Management Business to HealthStream

Change Healthcare sells its Capacity Management business, which includes services related to nurse staffing, patient flow, and anticipated patient demand, to workforce solutions company HealthStream.

Curbside Consult with Dr. Jayne 11/30/20

November 30, 2020 Dr. Jayne 4 Comments

A recent study looked at the idea that including a patient’s headshot in the EHR could reduce order entry errors. Although providers typically place orders on the correct patient greater than 99.9% of the time, researchers wanted to address the remaining 0.1%. The study was performed in the emergency department at Brigham and Women’s Hospital over a two-year period. They concluded that “wrong patient” orders were 35% lower for those patients who had a photo in the EHR compared to those who didn’t.

Although I’m supportive of the concept, I’d like to offer my own shortlist of solutions for error reduction in the EHR. Unfortunately, all of these were scenarios I’ve encountered in the last few weeks seeing patients. For the ones that are specific to the EHR (as opposed to operations or staffing), I’m not sure if the issue is truly caused by the EHR or by my group’s implementation of it. Because they so tightly control access to the vendor’s documentation, I have no way of knowing.

Medication Order Entry

Formularies should be configured to only support appropriate routes of administration. For example, in my EHR, if I select a medication to be prescribed to a pharmacy, I’m limited to the routes that are appropriate for the drug. Eye drops only display “ophthalmic,” oral medications only display “oral,” skin creams display “topical,” etc. It’s physically impossible for me to accidentally tell a patient to take their amoxicillin tablet topically unless I personally type it in the free text notes to pharmacy box, and even then, the pharmacy is going to catch it. For our in-house medications, however, some of them have options that aren’t appropriate, such as an IV push route of administration for drugs that should never be administered that way. It’s easy to click the wrong button, but removing the button would make the error impossible.

Similarly, doses should be hard coded so you can’t goof them up. If the office protocol is to prescribe famotidine 20mg IV every single time and to never use a different dose, why are we presented with a free-text field where we have to hand type it every time? We also have an issue where the in-house prescribing screen has navigation issues. You can’t tab from field to field, but rather have to move your hand back and forth from the mouse to the keyboard, which increases the chances that you might accidentally type “30” or “10” rather than “20” in the field if you’re in a hurry.

Orders should also be linked to avoid errors of omission. For example, if I’m ordering a liter of normal saline for IV hydration, I shouldn’t also have to order an IV catheter. I guarantee no one is going to try to do a straight venous injection of saline – of course they’re going to use an IV catheter. The system should also default timed infusions where appropriate. If the practice requires all infusions to be administered for at least 31 minutes in order to play the CMS coding game, then why not default 31 rather than making each of us type it every time?

Discrete Data Fields Should Be Appropriately Discrete

I cringe every time I have to document vital signs in our EHR. Blood pressure is a single field and requires the user to type the “/” in the middle and has no limitation on the field size. If my tech is having a bad day, I can get things like “180/1000” and the system doesn’t bat an eye (although it does flag it in red, at least). Someone at the vendor must have missed the memo on usability and not having a color change be the only indicator of an alert, though, because there is no other flag on the screen.

Especially for something like a blood pressure that you might want to graph or trend, the numbers should be captured separately, and the fields should be limited to reduce the risk of nonsense data entry. We have similar issues with height fields that aren’t configured to block nonsense entries. If someone doesn’t notice there are separate fields for feet and inches, you end up with patients that are 67 feet tall rather than 5’7” or 67 inches. Don’t get me started on our lack of use of the metric system with pediatric patients, which is the gold standard trained at most academic medical centers.

Use Technology to Assign Diagnoses That Make Sense to Both Provider and Patient

I’m a huge fan of systems that map ICD codes to patient-friendly and clinician-friendly terminology. Patients don’t want to see “R42: Dizziness and giddiness” documented on their charts. They want to see “vertigo” or “dizziness” or “lightheadedness” as appropriate with the ICD code behind the scenes. This is a pretty straightforward example, but there are dozens of wild and wacky codes and descriptions out there. Physicians hate it and I’m sure other clinicians do too. Patients end up with the wrong diagnosis on the chart when the provider struggles to find the correct one. Kudos to the IT folks who installed “the good stuff” technology wise to prevent this issue.

Use Technology to Keep Up with the Times

My EHR still does not have patient instructions for COVID. It’s ridiculous at this point. I diagnosed my first patient eight and a half months ago.

Reduce or Eliminate the Need for Multi-tasking Behaviors

This isn’t an EHR issue per se, but it’s the root of many of the errors we see. Clinicians need to be supported by their organizations and not expected to see patient volumes that are unsafe. Looking back to the pre-COVID world, my organization placed constant pressure on us to make sure that more than 95% of our patients were treated and released in under an hour. Sometimes that meant having one provider trying to juggle care for up to 15 patients depending on the number of rooms at the clinic. This can only lead to disaster depending on the experience of the clinician and the acuity of the patients’ issues. All staffing is driven by dollar signs, however, regardless of where you work.

One good thing that has come out of the pandemic is that they’ve capped the number of patients that can be roomed at a time based on the number of support staff, which means I rarely manage more than six patients at a time. It’s been a godsend and I can’t help but think it’s helped reduce errors, but at times it can still be unrealistic, especially when the patients are really sick and have a lot of labs and tests to manage. I have no idea whether those caps will stay in place as the pandemic eases, but I’m hopeful.

What error reduction strategies has your organization employed, or what seems obvious but hasn’t yet been implemented? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/30/20

November 29, 2020 Headlines 2 Comments

Health systems are using AI to predict severe Covid-19 cases. But limited data could produce unreliable results

Health systems are using AI to assign COVID-19 risk scores despite lack of proof that they correlate to real-world outcomes or whether their training was broad enough to be generalizable.

Federal system for tracking hospital beds and COVID-19 patients provides questionable data

A CDC analysis finds that HHS Protect’s COVID-19 data do not line up with other hospital data sources used by many states, potentially giving government health officials and hospital personnel inaccurate estimates of disease burden and resource availability.

Full implementation of P.E.I.’s electronic record system not planned until March 2022

In Canada, Prince Edward Island health officials postpone the implementation of an enterprise EHR due to COVID-19-related vendor delays, pushing the project to 2021-2022.

Monday Morning Update 11/30/20

November 29, 2020 News No Comments

Top News

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University of Vermont Health Network restores access to Epic at all locations nearly a month after malware took its systems down and forced recordkeeping back to paper.

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Epic MyChart was brought back online Friday, although new signups are not yet allowed and some test results will be presented as scanned documents. EpicCare Link was also restored, which gives community providers read-only access to the information of shared patients.

The health system says that bills, statements, and payment processing are delayed. Patient charges incurred since the October 28 downtime began have not been posted.

A New York Times article looks at the patient impact of the system downtime – cancer patients were sent away, staff used paper and their own memories to reconstruct chemotherapy protocols, and patients were not contacted to reschedule appointments for cancelled critical visits and imaging studies.


Reader Comments

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From WARN Actor: “Re: Providence Portland. Filed a WARN Act notice that it will lay off 183 employees in transitioning work to a third-party vendor. Wonder who the vendor is?” The affected positions all involve billing and coding and are located in the Portland Office Park. Christmastime layoffs always seem insensitive, but it sounds like almost all of those affected will be offered positions with the unnamed vendor.


HIStalk Announcements and Requests

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Thanks to readers who anonymously shared their total company compensation for 2020. I’m not much of a money-motivated guy, so my only reaction is to hope that every reader has enough income and assets to climb past the bottom two levels of Maslow’s Hierarchy of Needs (physiological and safety) to move more importantly to the three higher ones (love/belonging, esteem, and self-actualization).

New poll to your right or here: Of which groups are you a member?


Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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


People

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Reed Gardner, PhD, health informatics pioneer and professor emeritus of the biomedical informatics department of University of Utah, died last week at 83 of injuries he sustained in a fall.


COVID-19

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US hospitalizations for COVID-19 are at 92,000 as hospitals report a lack of beds and clinicians to staff them. The daily death count threatens to break its mid-April record as new cases approach 200,000 per day and lack of Thanksgiving precautions is likely to create a big upswing in the next two weeks.

State and local health officials are streamline or abandoning COVID-19 contact tracing efforts because while it would have been helpful in stemming outbreaks early in the pandemic, the virus is now spreading freely and there’s little to learn or gain when almost any group setting will include one or more infected people.

Stat reports that health systems are using AI to assign COVID-19 risk scores despite lack of proof that they correlate to real-world outcomes or that their training was broad enough to be generalizable. Stanford Health Care has developed its own model and is testing it against Epic’s free tool.

Anthony Fauci, MD says on a Sunday news program to “close the bars and keep the schools open,” noting that spread from and among children is not a significant issue.

In Brazil, the medical information of 16 million COVID-19 patients is exposed when a hospital employee uploads a worksheet containing login credentials to the country’s two coronavirus government databases to GitHub. The employee says he uploaded the file while working on a computer modeling project and forgot to take it back down.

Britain may begin mass COVID-19 vaccinations early this week as the country’s regulators are fast-tracking emergency approval of Pfizer’s product and potentially its homegrown AstraZeneca vaccine whose testing was flawed. The British government has pre-ordered 355 million doses of seven vaccine products. Its “Union unit” that fights UK breakup proposals, such as Scottish independence, is demanding that vials of the AstraZeneca vaccine bear the Union Jack, but Prime Minister Boris Johnson insists that nothing like that is being considered.

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The mayor of Longmont, CO backs away from his plan to make it illegal for the city’s two hospitals or other healthcare providers to provide services to COVID-19 patients who live in a county or city whose government refuses to comply with the state’s emergency orders, such as Weld County. Weld County’s commissioners have said they will ignore the state department of health’s Level Red restrictions and will leave it up to residents to do whatever they think is best, also noting that the case numbers are rising despite previous mandates.

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Sanford Health fires CEO Kelly Krabbenhoft following his email to employees in which he said he would not wear a mask because he believes himself to be immune following his coronavirus recovery.

All three quarterbacks of the Denver Broncos have been quarantined for five days following coronavirus exposure, forcing the team to start a wide receiver who last played quarterback in college. Meanwhile, the San Francisco 49ers are struggling to find alternatives for upcoming scheduled home games that won’t be allowed under new state restrictions.

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Sixty Air Force nurses spent Thanksgiving working at staff-stretched hospitals in North Dakota. Captain Ronald Golemboski, a nurse from the 96th Medical Group from Eglin Air Force Base who served multiple tours in Iraq and Afghanistan, summarizes, “It’s always hard. But as members of the Department of Defense, we’re tasked to fight all enemies, and that’s whoever and wherever they may be, including this virus.”


Other

A technologist says that videogame publishers are moving away from publishing apps – and the control and revenue they cede to app store owners Google and Apple – and instead are using advanced browser functionality. Apps won over websites in the early days because they were superior, but increasingly sophisticated browser capabilities paired with cloud computing would allow developers to release a single product version that would work on any device without being beholden to app stores.

In India, a hospital turns in a medical resident for hiring a nurse to impersonate him in making his hospital rounds and signing his timesheets, where the imposter wore a face mask to avoid detection.

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Practice Fusion founder and former CEO Ryan Howard pens an article titled “How to Prevent Your Company from Being Used for Evil From a Founder Who’s Been There,” making these points:

  • He says he was never contacted by the Department of Justice with regard to the opioid kickback scandal that cost Practice Fusion’s acquirer Allscripts $145 million to settle and he had no contact with opioid manufacturers while he was CEO.  He created the company to “drive better health and save lives” and “to make the world a healthier place,” so he was devastated to see his life’s work corrupted by the company after they fired him in 2015.
  • Companies should be operated as a B Corp to align purpose with profit.
  • Founder board seats should be made irrevocable, independent seats should have term limits to make it easier to get rid of board members who don’t follow the company’s core values, and common board seats should be pre-allocated to eventual investors.
  • Employees should commit to a code of ethics.
  • Capital should be raised from impact-driven funds that have a social impact focus.

Sponsor Updates

  • Gartner recognizes Everbridge in its “2020 Market Guide for Crisis/Emergency Management and COVID-19 Safe Return to Work Solutions.”
  • Fortified Health Security hosts a virtual food drive to support Second Harvest Food Bank of Middle Tennessee.
  • Priority Health expands its partnership with MDLive to offer out-of-state behavioral health coverage to its members.
  • Alcidion Group expands its reseller agreement with NextGate beyond Australia and New Zealand to include the UK and Ireland.
  • Nuance integrates interoperability standards from the RSNA and ACR Common Data Elements Steering Subcommittee into its PowerScribe One radiology workflow and reporting software.
  • OptimizeRx hires Ivan Zivkovic (Multicom) as senior java engineer.
  • The International Medical Center in Saudi Arabia will implement the TrakCare EHR from InterSystems across its hospitals and clinics.
  • Premier President Michael Alkire helps to raise $368,405 for cancer support nonprofit Family Reach.
  • Pure Storage expands its Service Catalog, offering transparent pricing for on-premises and hybrid cloud storage delivered as-a-Service.
  • India-based Narayana Health joins the TriNetX network.
  • WebPT honors Spear Physical and Occupational Therapy with its 2020 Ascend Practice of the Year Award and SymFit Physical Therapy and Fitness as the winner of the Innovator of the Year Award.

Blog Posts


Contacts

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

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Katie the Intern 11/27/20

November 28, 2020 Katie the Intern 4 Comments

Happy Thanksgiving, HIStalk! I hope you all had a wonderful and safe holiday yesterday. I know this Thanksgiving looked very different for the majority of us this year, but I hope your day was spent giving thanks and enjoying time with friends and family (distanced or not)!

This column will focus on another interview with a professional in the healthcare IT industry. This time, the focus leaned on the now and the next of healthcare IT throughout the pandemic. I really learned a lot about the nature of healthcare IT’s growth during strenuous times like these, and I hope this column relays some of that well.

Mike Pietig works for Avtex Solutions, an IT service management company founded in 1972 that offers full-service customer experience consulting and solutions. “Avtex is in the business of helping their clients deliver an exceptional experience to their own customers,” Mike said.

Mike has been with Avtex for a year, focusing on a healthcare line for customers who use the company. Avtex needed someone who was familiar with healthcare, who knew the right terms, regulatory requirements, and connections in the field. His role has helped the healthcare line of Avtex Solutions grow faster.

Because Avtex Solutions is a connection solution builder, the company is always seeking ways to solve problems and develop strategies for doing so. Mike has been in the healthcare IT field for about 17 years, and coupled with his workplace’s goals, I figured he would be a great person to talk about the major changes in healthcare IT. We broke it down into two major questions — how has healthcare IT changed and where is healthcare IT going next?

“The first big change was driven by regulatory requirements, government change that forced the healthcare industry to implement electronic medical records and other solutions to satisfy their requirements,” Mike said. “The innovation was happening within individual hospitals, but it wasn’t happening across an entire industry, so the government mandated some of those.”

Mike mentioned regulatory requirements such as the Affordable Care Act and the HITECH Act, both of which were written between 10 to 15 years ago and enforced more accessibility to health insurance and the use of EHRs. These rulings further pressed the healthcare industry as a whole to create platforms that were usable, valuable, affordable, and high speed.

Mike then turned to the pandemic itself to discuss another major change in the healthcare IT industry. COVID-19’s presence has acted as an accelerant that boosted the growth of telehealth, and prompted IT professionals to really ask how and why patients could get better care in a safe environment.

“I would say [COVID-19] probably accelerated innovation by somewhere between five years on the low end to 10 years on the high end, in terms of the technology solutions,” Mike said. “Also in terms of the adoption of telehealth, and virtual visits, and digital front doors, and the idea of consumer-driven healthcare.”

Mike also mentioned a client that had a year-long goal to implement telehealth in nine areas of their hospital. When the pandemic hit, the hospital knew they had to get telehealth going fast, and implemented all nine areas within six weeks.

Mike’s words lead me to think about COVID-19’s impact on not just healthcare in general, but at the fundamental level of how care is delivered. He said that patients need to be treated as a consumer, as someone who has choices where to go and how to get care instead of someone only interested in need-based care.

“We have to deliver a really great experience,” Mike said. “Because otherwise, those customers can take their business elsewhere. Healthcare is now really starting to recognize that.”

I was very curious about this trend, about why COVID-19 acted as a catalyst in a consumer-driven market during a time where the consumer is not necessarily the driving factor. Consumers are benefitting from the exponential growth of the healthcare IT market during a global pandemic because of how quickly providers have had to innovate solutions for safe patient care that slows the spread of the virus.

“We’ve got so many choices now that I’m going to go where I feel I can get the best outcomes and the best value and the best experience,” Mike said. “That is fundamentally different now than the way it has ever been in healthcare.”

Mike’s answers to the next part of my questions were just as interesting. Where is healthcare IT going next? If we’ve grown and adapted so quickly, what could possibly be next?

“I don’t think the technology will go away,” Mike said. “I think there is even more openness or an appetite to new ideas coming into healthcare because everybody is trying to figure out, ‘how do I do more with less?’”

Mike reflected on a recent survey of over 1,000 patients to find out what was important to them during this time in healthcare. Patients don’t want to wait in waiting rooms, touch clipboards, or touch a kiosk, Mike said. The top 10 concerns from respondents were centered on safety. The survey showed that people want quick, efficient, and safe care. Is this the trend that the future of healthcare IT will continue to follow?

Healthcare IT will continue to move forward, most likely with a heavy emphasis on telehealth and its ease of application. But Mike did say that the approval of initiatives is what takes the longest and can be the hardest to do. If an initiative or an idea can prove to be applicable not just when someone is sick, but all year round, it can move forward.

“If you’ve got a strong business case and you can generate more revenue, or measure the expected savings, people will still find the funding for it,” Mike said.

Mike talked a lot about how much he reads HIStalk and how impactful it is to him for work and for understanding the industry. I wanted this column to focus more on healthcare IT, but Mike did say that HIStalk is in his top three reading recommendations for newcomers at his work and for anyone new to the industry.

I know I mentioned doing some research on COVID deaths, but I received an interesting comment that I’d like to do a column on beforehand, if possible. User Kermit mentioned that a friend of theirs is a therapist, and I’d love to interview a therapist currently using a telehealth service to hear their ideas of the pros and cons surrounding its usage. Mr. HIStalk and I discussed the importance of researching the provider side of telehealth. I’d also love to interview a doctor about these aspects, so if you’re either of those or know someone, I’d love to connect.

That’s it for today! I hope you had a great Thanksgiving, and happy Friday!

Katie The Intern

TLDR: Katie The Intern interviewed Mike Pietig from Avtex Solutions. Mike said that the two major changes in healthcare IT over the years have been regulatory requirements and the pandemic as an accelerant for growth.

Katie

Email me or connect with me on Twitter.

Weekender 11/27/20

November 28, 2020 Weekender No Comments

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Weekly News Recap

  • Telemedicine kiosk vendor HealthSpot winds down its five-year bankruptcy with just $47,000 left to pay creditors after having raised $47 million.
  • The University of Vermont Health Network restores full access to Epic at all sites after a month of malware-caused downtime.
  • Germany-based health IT company CompuGroup Medical announces its intention to acquire ambulatory-focused health IT vendor EMDs for $240 million.
  • Phone-connected ultrasound transducer manufacturer Butterfly IQ will go public on the NYSE via a SPAC merger that values the company at $1.5 billion.
  • Cloudbreak Health and UpHealth Holdings use a SPAC merger to create a telemedicine company that is valued at $1.35 billion.

Best Reader Comments

That’s a lot of money for eMDs, though it isn’t clear how the financing works. At face value, it would take CompuGroup more than a decade to make their money back. It makes you wonder what Richard Atkins has been doing. He was brought in to sell Greenway Health and apparently there are buyers interested in that kind of small practice EHR business. Why can’t he make the sale? (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. B in North Carolina, who asked for a globe carpet for a reading area for her elementary school class. She reported in late April, “The students have really enjoyed using the bean bag and carpet for flexible seating. They race to get there every day when we have flexible seating time. It is a joy to see them being so comfortable while learning. Your donation has also brightened our learning environment. The carpet is so colorful and matches perfectly with our World theme. I am a global educator and as such tries very hard to make my students globally and culturally aware. Your carpet does that. They have tried to identify the continents and places on the carpet. Thank you for allowing my students this opportunity to be in a comfortable learning space and also to have flexible seating. They absolutely love it!”

Employees of NYC Health + Hospitals say that everybody was in favor of providing extra compensation for COVID-19 overwhelmed frontline employees as long as someone else footed the bill, turning the process into a meme: “How did your hospital reward you for being essential, and what type of pizza was it?”

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Pulmonologist Joseph Varon, MD is captured in a photo taken in Houston’s United Memorial Medical Center comforting a COVID-19 patient in the ICU in his 252nd straight day of working in the hospital.

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A recently licensed nurse’s “how it started, how it’s going” photo of herself a at graduation and then after working in the ICU shows the toll that COVID-19 takes on caregivers.

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Orthopedic surgeon Elvis Francois, MD has a big Wednesday – he is unmasked on “The Masked Singer” and is named to People magazine’s “Sexiest Man Alive” list.


In Case You Missed It


Get Involved


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Morning Headlines 11/26/20

November 25, 2020 Headlines No Comments

$47M invested, $47,000 left for creditors: HealthSpot bankruptcy winding down

After five years in bankruptcy, telemedicine kiosk vendor HealthSpot has just $47,000 left to distribute to creditors.

UVM Medical Center restores electronic medical records nearly a month after cyberattack

The University of Vermont Health Network announces that it has restored access to its Epic EHR for all inpatient and outpatient sites.

Elizabeth Holmes Prosecutors Say Texts Show Theranos Beset With Problems

Federal prosecutors seek a judge’s approval to use texts between Theranos founder Elizabeth Holmes and former president Sunny Balwani to help prove they knew that the company’s technology was not as groundbreaking as they led investors to believe.

Morning Headlines 11/25/20

November 24, 2020 Headlines No Comments

Well Health Secures $45 Million in Series C Funding to Transform Patient Communication for Healthcare Providers, Payers, and ACOs

Digital patient communications company Well Health raises $45 million in a Series C financing round, bringing its total funding to $75 million.

DataLink Receives Growth Equity Investment from Investor Group Led by DWS

Population health software company DataLink will use a growth equity investment to further scale its provider engagement services and pursue M&A activities.

Healthcare technology maker G Medical Innovations withdraws $30 million US IPO

G Medical Innovations, an Israel-based vendor of remote vital sign monitoring software, withdraws its IPO plans – for the second time – after filing to raise $30 million on the Nasdaq.

News 11/25/20

November 24, 2020 News 1 Comment

Top News

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Germany-based health IT company CompuGroup Medical will acquire ambulatory-focused health IT vendor EMDs for $240 million.

CGM paid a similar amount earlier this year to acquire Cerner products that are marketed in Germany and Spain.

EMDs, which acquired competitor Aprima nearly two years ago, employs 1,400 people in the US and India to serve 60,000 practice-based end users.


HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Lumeon. The Boston-based company helps health systems take control of their care delivery processes by orchestrating and automating care journeys to operate with predictability and efficiency. It acts as the auto-pilot for healthcare delivery in coordinating teams, communications, tasks, and decisions to deliver superior outcomes at a lower cost, optimize resource utilization, and increase revenue. Lumeon’s solutions are enabled by their cloud-based care pathway management (CPM) platform. Capitalizing on the patient’s electronic health record (EHR), health systems can start simply with immediate benefits and evolve to orchestrate their entire care process. More than 70 progressive health systems across 12 countries have deployed Lumeon’s multi-award-winning platform. Thanks to Lumeon for supporting HIStalk.

I found this Lumeon explainer video on YouTube.

Listening: the new studio album from AC/DC, which won’t change your mind about the band either way since its sound is so predictable that it could be generated by AI. The accomplishment here is perseverance rather than boundary-pushing, but that alone is remarkable enough given the recent loss of Malcolm Young to dementia and then death, the dismissal of Brian Young due to hearing loss, the home imprisonment of drummer Phil Rudd for attempted drug-related murder for hire, the resignation of bass player Cliff Williams, and the presence of “where’s all me mates gone” 65-year-old schoolboy uniform-wearing Angus Young as the only remaining original member until recently. Johnson is back at 73 years of age after successful hearing treatment, Rudd returns post-incarceration, and Williams is back as a tribute to Malcolm Young, restoring to 60% the count of current members who were heard on 1979’s “Highway to Hell.” AC/DC’s recent business plan has been releasing a loss-leader album of songs that are indistinguishable from their hits, then cranking up the touring cash machine for fans who are happy to expensively relive their youth’s soundtrack of “Back in Black” and “Dirty Deeds Done Dirt Cheap” for the thousandth time. Monetization will thus be a race between COVID limitations and the bandmates’ advancing years, but at least they’ve put out their first studio album in six years and it holds the #1 spot on Billboard’s chart, only their third album to summit that commercial apex (“Back in Black” was a curve-flattened release, selling 25 million copies, but over such a long period that it peaked at #4).


Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

December 3 (Thursday) noon ET. “Unlocking the Power of Data: How HIEs Can Better Support Their Participants.” Sponsor: Intelligent Medical Objects. Presenters: Jaime Bland, DNP, RN, CEO, NEHII; Naresh Sundar Rajan, PhD, CTO, NEHII; Matt Cardwell, PhD, VP of client services, IMO; John Laursen, VP of business development, IMO. HIEs need accurate, actionable, and normalized EHR data to unlock its analytic power to support alerting, regulatory reporting, interoperability, and clinical surveillance. The presenters will describe how to interpret the descriptions and standard code sets that health system partners send, how leading HIEs use normalized data to improve their client and community offerings, and how a new normalization approach may provide operational savings.

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


Acquisitions, Funding, Business, and Stock

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AI-powered predictive data modeling vendor ClosedLoop.ai raises $11 million in a Series A funding round. Co-founder and CTO Dave DeCaprio helped lead MIT’s Human Genome Project before stints at GNS Healthcare and Mount Sinai’s Icahn School of Medicine.

Special purpose acquisition company GigCapital2 will merge with Cloudbreak Health and UpHealth Holdings to create a digital health management company that will be valued at $1.35 billion. The SPAC raised $150 million during its 2019 IPO and plans to raise another $160 million to finance the deal.

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Digital patient communications company Well Health raises $45 million in a Series C financing round, bringing its total funding to $75 million.


Sales

  • Union Hospital (IN) selects Masimo’s SafetyNet patient management system to help discharged COVID-19 patients recover at home.

People

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Dana Safran (Haven) joins Well Health as SVP of value-based care and population health.

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University of Utah School of Medicine hires Yves Lussier, MD (University of Arizona) as chair of biomedical informatics.

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Sarah Sample-Reif (Incredible Health) joins Zivaro as chief strategy officer.


Announcements and Implementations

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Philips announces a vendor-neutral Radiology Operations Command Center that uses telepresence to conduct imaging operations virtually.

In England, Leeds Teaching Hospitals NHS Trust goes live on Agfa HealthCare’s enterprise imaging software.

Campbell University (NC) and Wayne HealthCare (OH) implement Emerge’s ChartGenie data-conversion technology as they respectively prepare to implement Athenahealth’s EHR early next year.

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Kettering Health Network (OH) adds CenterX’s real-time prescription benefit and electronic prior authorization capabilities to its e-prescribing workflows within Epic.

A Lumeon survey of patient access executives finds that patient experience and access to care will be their most important differentiators in 2021, while more than half believe that fragmented processes and technology – such as the 72% of providers that still manually call waitlisted patients to fill cancelled appointments — prevent them from meeting their patient access goals


COVID-19

The number of hospitalized COVID-19 patients hit another record Monday at 85,836. The COVID Tracking Project warns that states probably won’t file complete reports until next week and thus numbers will be underreported as they were over Labor Day. It’s fascinating that a pandemic that has killed 258,000 Americans still doesn’t warrant state employees working weekends and holidays.

Experts say that CDC’s warning last week that small gatherings involving non-cohabitants are responsible for a lot of COVID-19 spread is not supported with data, but has been repeated enough times to convince states to limit such gatherings, perhaps illogically. US contact tracing has been overwhelmed with non-participation and overly wide coronavirus spread, but where state data is available, the leading sources of infection spread remain long-term care facilities, food processing plants, prisons, healthcare settings, restaurants, and bars. The New York Times notes that while Minnesota’s governor has banned people from different households from meeting indoors or outdoors, the state still allows churches, funeral homes, and wedding venues to hold indoor gatherings of up to 250 people. A Vermont ban of neighbors walking together distanced and masked while restaurants remain open for indoor dining is “bizarre,” says an infectious disease modeler who notes, “I can get together with nine of my best friends and sit around a table at a restaurant, so why can’t I do that in my house?”

Urban hospitals are being overwhelmed by COVID-19 patients from rural areas in which masking orders are either absent or ignored, with the head of Kansas City’s health department saying that it’s unfair for city residents to be denied an ICU bed that is occupied by a resident of a county that goes mostly maskless.


Other

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Federal prosecutors seek a judge’s approval to use texts and other digital exchanges between Theranos founder Elizabeth Holmes and former president Sunny Balwani to help prove that the pair – who were once romantically linked – knew that the company’s technology was not as groundbreaking as they led investors to believe. Messages refer to terrible validation reports, the “painful” FDA approval process, and one of their labs being a “disaster zone.” The delayed trial will take place in March.


Sponsor Updates

  • Unite.ai features Saykara founder and CEO Harjinder Sandhu.
  • Change Healthcare will participate in a fireside chat during the Guggenheim Digital Health Virtual Summit December 8.
  • Clinical Architecture releases a new podcast, “Healthcare Terminology Standardization and Normalization.”
  • InterSystems releases HealthShare 2020.2 with expanded HL7 FHIR API capabilities

Blog Posts


Contacts

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

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Morning Headlines 11/24/20

November 23, 2020 Headlines No Comments

CompuGroup Medical strengthens US business with one of the largest acquisitions in company history

Germany-based health IT company CompuGroup Medical will acquire ambulatory-focused health IT vendor EMDs for $240 million.

GigCapital2 to merge with two telehealth firms in $1.35 billion deal

Special purpose acquisition company GigCapital2 will merge with Cloudbreak Health and UpHealth Holdings to create a telemedicine company valued at $1.35 billion.

Signify Health Acquires PatientBlox to Accelerate Prospective Episode of Care Payment Models, Advance Transition to Value-based Care

Value-based care coordination and payments vendor Signify Health acquires blockchain startup PatientBlox for an undisclosed sum.

CentralReach Acquires AI-Based Scheduling Algorithm to Automate Scheduling Operations for Autism & ABA Care Delivery

Health IT vendor CentralReach acquires Cartocal and will incorporate its automated scheduling technology into its software for providers specializing in applied behavior analysis.

Curbside Consult with Dr. Jayne 11/23/20

November 23, 2020 Dr. Jayne No Comments

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The Center for Medicare & Medicaid Innovation (aka the CMS Innovation Center) announced the list of participants in the Primary Care First initiative this week. The program was delayed due to a variety of issues prior to the pandemic, which really pushed it back. It’s finally slated to start on January 1, 2021.

I wonder how the selected participants feel about having roughly 40 days to get everything in place? Most of them have been working on other initiatives that share the same goals as this program for some time, but it’s an entirely different thing to actually get a new program ready to launch in your organization. Trying to do so in what most people are experiencing as the largest peak of the pandemic is yet another level of pain altogether.

What is Primary Care First? It’s been so long since I talked about it that many of us have probably forgotten. It was designed as a voluntary alternative payment model slated to “reward value and quality by offering innovative payment model structures to support delivery of advanced primary care.” The program is supposed to last five years. More than 900 primary care practices were selected and there are 37 identified regional partnerships with commercial, state, and Medicare Advantage plans. Practices had to be in an area with a regional partner in order to participate, which excluded a good chunk of the country.

The program changes the payment structure for patients in participating plans, with the idea that even though not all the patients in the practice may be covered by one of the partner payers, that the practice would effectively up its game in delivering the same level of high-quality primary care services to all patients.

In exchange for performance-based payments and reduced administrative burdens, practices agree to assume financial risk as they try to reduce the total cost of care. There is also a so-called “seriously ill patient” option for practices that treat high-need, seriously ill patients who don’t currently have a primary care provider.

Overall, the model is supposed to revolve around patient-focused care and a high level of care coordination. The reduced administrative tasks are supposed to free providers to spend more time with patients. The program is also designed to “foster practitioner independence by increasing flexibility for primary care, providing participating practitioners with the freedom to innovate their care delivery approach based on their unique patient population and resources.”

Practices are scored based on clinical quality and patient experience measures which include: a patient experience care survey, controlling high blood pressure, diabetes hemoglobin A1c control, colorectal cancer screening, and advance care planning.

I’m sure the practices that applied many months ago had no idea where we would be come January 1, and I wonder if many of them might try to opt out. The final selection of 900-odd practices is quite a way off from being representative of the roughly 210,000 primary care physicians in the US. I’m not even sure, given some of the other variables that were involved in selecting the participants, that the cohort will be able to generate the statistical power needed to prove whether its outcomes (clinical and financial) are truly better than other care delivery paradigms. These practices have been at least dipping their toes in the waters of value-based care for years, with many of them being mostly submerged.

The list of payer participants is dominated by Humana, with a handful of other plans and a sprinkling of Blue Cross / Blue Shield players. Looking at the practice list, it’s a little tricky trying to tell who is who because the participants are mostly listed by the name of their brick and mortar entity, which may not portray the health system ownership behind them. I learned about these naming relationships the hard way: when I was employed at a practice owned by Big Hospital System, they were keen on each practice having its own brand, which wasn’t always the greatest idea when they upcharged you for customizing various things with the practice name versus just being able to say “BHS Medical Group” in your outbound reminder messages, etc.

A couple of the big players show up with a handful of practices each: AdventHealth (formerly Adventist), Ascension, Baptist Health, Beaumont, Cambridge Health Alliance, Cedars-Sinai, Cleveland Clinic, John Muir Physician Network, Temple Physicians, Virtua Primary Care, and Warren Clinic. The University of California has the most participation with 39 sites, and OhioHealth is the runner up with 26 locations. My state isn’t part of the identified Primary Care First regions, so I won’t be able to get very many in-the-trenches stories from regional peers, but I did see at least four of my former clients on the list. Hopefully my contacts are still working there and are willing to keep me posted on how things are going.

Even for the practices with the most value-based care experience, trying to launch this program during a surging pandemic will be key. Colorado is a participating state, and recent reports estimate that 1 in 49 Coloradans are COVID-positive right now. Practices that are reeling with those kinds of numbers are going to be hard pressed to spend time preparing to embrace prevention and management of chronic diseases, which are certainly being exacerbated by the pandemic.

In the urgent care space, I see so many patients who either can’t get in to see a primary care physician or whose physicians have frankly abandoned them. My friends in telehealth report dramatic increases in the number of patients requesting visits for COVID-like symptoms. There’s even a surge in people who have had COVID tests at drive-through clinics but who are struggling to reach their primary physicians and are reaching out to telehealth providers to get documentation that they meet CDC guidelines to return to work.

I wish the best for the Primary Care First practices. We need to bolster our primary care and public health infrastructures – of that, there is no doubt.

We had a conversation at urgent care yesterday around what the health care system will look like in the US after it’s been completely decimated by COVID. This was right after we were notified that four providers had been diagnosed the day before, including the one who had been sitting at my workstation less than 12 hours previously. The nearly 100 patients I saw have no idea what kind of bills are coming their way, especially if they are positive and need hospitalization. I see a tsunami of medical bankruptcies on the horizon. If the Affordable Care Act is repealed and more people have to pay out of pocket for preventive services, I don’t see them having tremendous cash reserves to do so, and this could drive even greater healthcare expenditures down the road.

I’ll continue to follow the adventures of Primary Care First and report back with what I find. If you’re involved in the initiative, I’d love to hear from you. Until then, stay healthy, stay safe, and stay six feet back.

Email Dr. Jayne.

Morning Headlines 11/23/20

November 22, 2020 Headlines No Comments

UVM Medical Center takes cautious steps to restore services after cyberattack

University of Vermont Health Network begins restoring access to Epic beyond a read-only view at inpatient and ambulatory sites of UVM Medical Center.

ClosedLoop.ai Secures $11M Series A Funding to Assist Healthcare Organizations Improve Clinical and Financial Outcomes

AI-powered predictive data modeling vendor ClosedLoop.ai raises $11 million in a Series A funding round led by Greycroft and .406 Ventures.

Butterfly Network, a global leader in democratizing medical imaging, to be listed on NYSE through a merger with Longview Acquisition Corp.

Phone-connected ultrasound transducer manufacturer Butterfly IQ will go public on the NYSE in a merger with a special purpose acquisition company that values the company at $1.5 billion.

VA Moves to Expand Its 5G Experimentation

The VA will expand its 5G testing to sites in Florida and Seattle following its initial work in its Palo Alto hospital, looking at technologies such Microsoft HoloLens for surgical navigation and adding telemetry monitoring to new areas of hospitals.

Monday Morning Update 11/23/20

November 22, 2020 News No Comments

Top News

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University of Vermont Health Network begins restoring access to Epic beyond a read-only view at inpatient and ambulatory sites of UVM Medical Center. The health system says that effort will require several days, with other sites to follow.

The health system will need to back-enter data nearly 30 days’ worth of manually recorded data. UVM systems have been down since October 28.

The IT team will focus on restoring MyChart once they have brought Epic back up.


HIStalk Announcements and Requests

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Poll respondents are optimistic about their job prospects for the next year, with 80% of them expecting to hold the same or better job and 80% of those assuming they will be working for the same employer.

New poll to your right or here, and of course your answers are not trackable or identifiable: How much total compensation will you receive from your primary employer in 2020?

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Welcome to new HIStalk Platinum Sponsor Emerge. The Dallas-based company’s solutions empower healthcare professionals with superior medical data intelligence, resulting in enhanced workflows, increased efficiency, and higher quality of care. ChartScout, launched by SSO from the EHR, removes the barriers between caregivers and EHR data by accessing data from structured, free-text, and scanned image data, providing an intuitive patient chart search and visualization and personalized dashboards to facilitate patient overview and management by showing care gaps, calculations, scores, and decision support. ChartPop provides a tailored, cross-sectional view of the active patient population to create pursuit lists, fill gaps in care, and work toward better population management. The ChartGenie data conversion service provides a seamless transition between an old EHR to a new one and/or into Emerge’s cloud. A subscription also provides access to the data from both systems into a single synthetic patient view using ChartScout and ChartPop, removing data siloes and the need for toggling between EHRs. Thanks to Emerge for supporting HIStalk.


Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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


Acquisitions, Funding, Business, and Stock

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Phone-connected ultrasound transducer manufacturer Butterfly IQ will go public on the NYSE in a merger with a special purpose acquisition company that values the company at $1.5 billion.


Announcements and Implementations

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Drug company Bayer will support five startups as part of its G4A Digital Health Partnerships Program. The initial class of early-stage companies are Caria (evidence-based menopause support), Elly Health (audio chronic condition education), Decipher Biosciences (genomic testing), Sweetch (data-powered disease management recommendations), and MyOnCare (patient and care team communication).


Government and Politics

The VA will expand its 5G testing to sites in Florida and Seattle following its initial work in its Palo Alto hospital, looking at technologies such Microsoft HoloLens for surgical navigation and adding telemetry monitoring to new areas of hospitals.


COVID-19

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COVID-19 tests, new cases, and hospitalized patients set records Friday, with 82,000 hospital inpatients straining capacity in many areas.

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About 1,000 hospitals have reported critical staffing shortages to HHS, although not all hospitals are submitting staffing data to the abruptly implemented HHS Protect reporting system. Hospitals note that while it’s easy to add beds, shortages of skilled personnel will force them to prioritize who receives care.

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Henry Ford Health System has had 169 employees test positive for COVID-19 in the past week, straining the five-hospital system as 19% of 900 workers were found to have coronavirus.

St. Louis hospitals say that state reports showing hospitals with plenty of available regular and ICU beds are dangerously misleading to the public, as the information that is reported to the federal government looks at beds that are licensed, not those that are staffed for appropriate COVID-19 care.

The government says that shipments of Pfizer’s COVID-19 vaccine could start December 11, the day after FDA’s vaccine advisory committee meeting, assuming its data review is positive.

Operation Warp Speed scientific advisor Mocef Slaoui, PhD tells CNN that he expects US life to return to somewhat normal by May as a significant portion of the population will either have received a vaccine or recovered from previous infection with some degree of immunity, slowing coronavirus spread.

WHO recommends against using remdesivir to treat COVID-19 after an expert panel’s review of studies finds that it does not improve any important patient outcome, including the rate of ventilation and death. FDA gave the Gilead drug fast, full approval in October despite modest results from questionably rigorous studies.

Updated CDC guidance says that most COVID-19 infections are spread by people who do not have symptoms, making mitigation measures even more important.

Most health systems that were polled by Premier say they aren’t ready to receive and manage the administration of COVID-19 vaccines. Issues:

  • Pfizer’s vaccine requires storage at –70 degrees Celsius, which will require procurement of large ultra-cold freezers in each health system market or location and development of dry ice policies and procedures.
  • Some health systems have been designated as state vaccine distribution hubs and will need to track location, quantity, and storage temperatures in real time.
  • CDC has not yet announced how populations will be prioritized to get the vaccine.
  • Healthcare workers who will get the vaccine early will need to be pre-scheduled for staggered appointments to avoid potential coronavirus exposure while waiting in lines.
  • IT systems will need to be evaluated to capture and report vaccine storage, vaccinations administered, doses on hand, and participation in training programs, with all of the information ideally linked to the health system’s EHR.
  • Appointments for the second dose of the two-dose regimen should be made during the first-dose visit, followed by reminders to the phone number and email address captured at that time, to make sure patients receive the second dose.

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The Texas National Guard sends 36 troops to El Paso to help overworked morgue personnel deal with the large number bodies of coronavirus victims and setting up a new central morgue expansion.


Other

Expert authors say in a Harvard Business Review article that telehealth has great promise, but unintended consequences include exacerbating disparities in access and challenging clinicians with video fatigue, longer work days, and a blurring of work-life boundaries. They also note that virtual visits can increase healthcare spending via new utilization. They use HITECH experience with EHRs to suggest facilitating equitable access by offering digital help and language interpretation, engaging patients and their families, scheduling provider virtual visits in specific sessions instead of on top of a full workday, and integrated telemedicine platforms (especially those offered by for-profit telehealth services) with EHRs for continuity of care.

A Singapore doctor search and patient review website raises the ire of country’s medical and dental membership organization, whose practitioner information the company apparently scraped from its website without permission. The company says it will ignore the request of Academy of Medicine, Singapore to remove its details about practitioners and will also ignore any requests of AMS members who ask not to be listed.

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The Pro Football Hall of Fame honors Laurent Duvernay-Tardif, MD, who skipped the 2020 season as right guard for the Super Bowl champions Kansas City Chiefs to work as an orderly in a long-term care facility on the COVID-19 front lines.


Sponsor Updates

  • OptimizeRx hires Nick Hill (Passport) as director of project management.
  • PatientPing publishes a new Use Case Spotlight, “How Heartland Alliance Health Improves Patient Engagement and Care Coordination Outcomes for Vulnerable and High-risk Patients.”
  • Cerner appoints Major General Elder Granger, MD, US Army (retired) to its Board of Directors.
  • Pure Storage introduces the Pure Validated Design Program to simplify deployment of partner solutions.
  • Redox releases a new podcast, “No Beers, No Bars, just ELRs: Electronic Lab Reporting Requirements with Dr. Louise Laurent.”
  • Relatient and TriNetX ranks on the Deloitte Technology Fast 500.
  • SOC Telemed will present at the virtual Piper Sandler Healthcare Conference December 2.
  • Waystar publishes the results of a new study, “Consumer Attitudes Toward Medical Bills + the Price Transparency Rule.”
  • Well Health and Wolters Kluwer partner to embed EmmiEngage interactive multimedia programs on diabetes education into the Well platform.

Blog Posts


Contacts

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

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Katie the Intern 11/20/20

November 20, 2020 Katie the Intern 1 Comment

Howdy, HIStalk readers! I’m back with another interview column that covers a HIStalk reader who is a professional in the field. On top of learning about the healthcare industry and the consulting side of IT, I also got some great advice about how to take a deep dive into learning about the ecosphere as a whole. Buckle up! 

I interviewed Zack Henderson with Pivot Point Consulting last week. Zack is a senior consultant who works in the implementation of Epic’s different modules and programs. “I work really closely with their analysts, their users, the operational leadership to develop training programs,” Zack said. “Specifically, for their emergency departments, their obstetrics, their long-term care, and case management control.”

I asked Zack to explain to me a little about what Pivot Point does, as I am unfamiliar with the term “consultant” in its application to healthcare IT. Zack said that his company works with several clients in a five-hospital health system in Illinois where he is based, but also across the United States. Pivot Point works on EHRs, ERP (Enterprise Resource Planning, yes, it has been added to my Google doc of abbreviations), analytics, telehealth, and other projects. He has been with Pivot Point for about a year. 

Before Pivot Point, Zack worked for Epic. Zack, like most Epic employees, was brought into Epic with little experience and no history as an HIStalk reader. 

“I came across HIStalk when I started working at Epic. It was one of the online sources that they [Epic] recommended we visit and try to go explore,” Zack said. “It was a great source for a lot of us, and it continues to be. Being able to read those stories and asking, how is that going to change the work that I am doing in a year? In five years?” 

I found it fascinating that Epic encouraged employees to read HIStalk and other IT blogs to gain experience. It is eye-opening for someone who is new to the field and new to HIStalk to see the reach of HIStalk and its impact. Zack said that HIStalk helped him become familiar with how many different aspects there are in the healthcare IT world. 

“Having moved on and into the consultant world, every day I feel like I learn about a new app or a new regulation or a new feature to try out or a new product that is being brought to market,” Zack said. 

There were stories and discussions that were used for training at Epic, Zack said, but much of his HIStalk reading was used to look at the macro level of the health care industry — where the industry is going, new tech such as AI and voice activation, and cool things that are happening. HIStalk keeps Zack in the loop of what is new to the industry. 

“I visit HIStalk about every other day and find it to be a great one-stop shop for keeping up with everything going on in the world of healthcare IT,” Zack said. “I pay particular attention to news about EHRs, specifically news about Epic customers as well as stories about mergers, acquisitions, divestitures, and strategic HIT efforts by health systems.”

Zach also talked about how he appreciates the variety of pieces that HIStalk covers, sharing his love for the various interviews that help him understand what problems and solutions are being solved with technology. He also said that Dr. Jayne’s columns remind him of the impact that technology has on and with patient care. 

“The world of healthcare IT is so broad and there’s always something new and cool being worked on,” Zack said. He’s not exaggerating, as I am just beginning to learn the intersections of healthcare and technology and their interconnected impact on each other and on the world. I asked Zack for some advice about learning and understanding these things better as I become more immersed in the industry. His main piece of advice was to research some of the historical aspects of the healthcare IT world. He mentioned researching Dr. Plummer at Mayo back in the 1900s, so I did just that. 

Dr. Henry Plummer was a scientist and engineer who entered the healthcare field as a physician’s assistant in the late 1800s. Even before working in the health field, Dr. Plummer took an interest in the endocrine system at the age of 16. This lead to a medical degree from Northwestern University, which fueled his impactful medical career. 

Dr. Plummer was hired by Dr. William Mayo, director of the fledgling Mayo Clinic, in 1901. Dr. Plummer wanted to create a streamlined system of patient information access because doctors originally only kept single notes on separate patients. Alongside his colleague, Mabel Root, Dr. Plummer initiated a chart system of patients so that doctors could easily access information in one place. The medical record was born on July 1, 1907, and has only grown from there. Dr. Plummer served Mayo Clinic until his death in 1936. 

Zack’s advice to look at this history led to more research about how quickly the EHR developed over time. Hardware became more widely available as early as the 1920s, and though the internet was not created until the 1960s, the growth of the health records system was consistently exponential. While there was only one health record in 1907 at just one clinic (Mayo), as of 2017 86% of office-based physicians use or have used an EHR. 

Understanding an important piece of the healthcare IT world, EHRs, has given me a strong foundation into the impact of technology and how it can literally change and save lives. I enjoyed learning about Dr. Plummer and the growth of the health records system, now electronic, and want to continue this kind of historical study. The technological advances we know in this industry today were developed from a single idea, and as Zack said, Dr. Palmer “…really set the course for where we are now.” 

I think the best piece of advice I received from this interview is something that I am coming to find as I learn. I’ll let Zack’s quote end us out, as he says it best. 

“Healthcare IT is just really cool. The macro-level work that we get to do in this field is really, really cool and we get to impact millions of lives.” 

That’s it for today! Hope you all have a great weekend. Thanks, as always, for reading and for welcoming me. 

Katie The Intern

Katie

Email me or connect with me on Twitter.

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Reader Comments

  • WestCoastCFO: Re: Olive. Not seeing it, what am I missing? They seem to have found a nice niche, but they are not what I would call...
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  • AnInteropGuy: Of the six EHRs I am familiar with, I have seen at least one or two of the problems described in each of them. Certainly...
  • Robert D. Lafsky M.D.: Stupid question: Why can't you name an EHR when you talk about its flaws? Answer honestly....
  • AnInteropGuy: I would hope that we have better medicine and science than we did 67 years ago. Our understanding of virus mechanisms ar...

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