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Weekender 4/16/21

April 16, 2021 Weekender No Comments

weekender 


Weekly News Recap

  • Digital health vendor K Health, insurer Anthem, and investment firm Blackstone form Hydrogen Health.
  • CHIME will integrate its Spring Forum into Vive, an annual health IT event it will co-host with the HLTH conference beginning next March.
  • Mayo Clinic launches Remote Diagnostics and Management Platform.
  • The VA reaffirms that it will not bring its second Cerner site live in Columbus, OH until it has completed a strategic review of the project and shared the results with Congress.
  • AI solutions vendor Olive acquires Empiric Health, which offers AI-powered surgical analytics software.
  • Google will conduct a user feedback study as it prepares to develop a consumer-facing health record tool similar to Apple’s Health Record app.
  • Microsoft announces that it will acquire Nuance in a deal worth nearly $20 billion.
  • HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term.
  • US News & World Report highlights the legal efforts of Hoag Memorial Hospital Presbyterian to leave the 51-hospital Providence system, with a key issue being clinical standardization as enforced by configuration of Epic.

Best Reader Comments

I think this acquisition makes a lot of sense for Microsoft. The future is not on a mouse and keyboard, it’s voice control and augmented reality. There will be an exciting opportunity to integrate this with the Holo Lens which as far as I can tell is one of the more mature AR gadgets out there. When you pair Dragon + Holo Lens + Hey, Epic! and other types of integrations, you have the potential for a must-have product for certain types of providers. As others noted, this will be yet another reason for existing customers to adopt Azure and/or Azure AD. Azure AD identity integration is going to play a bigger role in healthcare consolidation than people realize. Managing healthcare user identities for external users and mergers is a PITA and Azure AD helps reduce the complexity quite a bit. Dragon can now bolt right on to that. (Elizabeth H. H. Holmes)

I would add that Cortana hasn’t been well received by the market, so picking Dragon’s voice rec is a nice cherry on top of the reasons you state. They may not plan to sell a lot of the standalone product, but adding underlying technology to their stack is appealing. The talent acquisition is also nice. (Jim)

If they are paying 14 times rev for Nuance AND they manage to get almost all the Nuance revenue into the Azure “bucket” AND revenue to Azure is more profitable than the rest of MSFT and bumps up overall market cap, can they mark this whole thing as a win by adding more to MSFTS market cap? (Matthew Holt)

Re: Hoag. A hospital in Orange County (with cash–rich patients who are willing to come up out of pocket to pay for healthcare) has more ability to consumerize healthcare and give patients every option and ultimately, deliver what the patients want. Providence has facilities that can’t do that. But does that really change the ‘standard’ of care? (ellemennopee87)

Raise your hand if you’d like to see the data use agreement for Google’s PHR (I say this while realizing I’ve turned over 90% of myself to them already). The portal is like the only thing about healthcare I enjoy. Seems like another PHR failure in the making. (Android user)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. W in Washington, who asked for a microphone, drawing tablet, ring light, and phone video stand for creating online lessons for her elementary school class. She reported last winter, “Beginning the school year remotely was difficult, but thanks to your help, my students have been performing to their very best online. My science classes have become familiar with Microsoft Teams, and have been working with Class Notebook (a version of One Note) specifically for science. This program has allowed for easy access to and organization of class notes and activities. Implementation has been so successful that I plan on going paperless for the majority of class activities for years to come. Being able to provide my students with high quality recordings, in which multiple screens can be viewed simultaneously, has been a blessing this year. The audio and visual quality of the content I can deliver has improved immensely with these items, and has helped our English language learners as well as special needs students to succeed in this new environment. I can’t wait to share these tools with students once we are able to meet in person in the classroom.”

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Montefiore Hospital (NY) implements sleep pods that allow frontline workers to relax and energize. The HOHM pods, which are reserved via a tablet app, offer a massage chair, a privacy curtain that blocks sound, and a charging station.

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Police bodycam video captures officers shooting a patient dead in the ED of Mount Carmel St. Ann’s Hospital (OH). Miles Jackson, 27, struggled with officers who felt a gun in his pants that had been missed in an incomplete pat-down. Jackson said he would comply with commands to put his hands up but was scared the officers would shoot him, after which an officer took him down with a stun gun and he was then shot by multiple officers after his gun discharged. Westerville’s police chief says he has “concerns that warrant further review.” Jackson had been taken to the ED after being found unconscious of a suspected drug overdose in a car and was being arrested in the ED on outstanding warrants.

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Police charge a 31-year-old South Florida Botox clinic nurse practitioner with anonymously calling two elderly women and convincing them to wire her $20,000 to help one of their relatives that had been injured. She was also charged with drug trafficking when the arresting officers found 170 pounds of marijuana in her apartment.

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The local paper profiles LaVonne Smith (at left above), who just retired as IT director of Tomah Health (WI) after a 40-year career, 36 of which was spent in IT after she was drafted from the admissions department in 1985 to help implement the hospital’s first computer system. The health system went live on Epic in 2017.


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Morning Headlines 4/16/21

April 15, 2021 Headlines No Comments

K Health, Blackstone Growth, Anthem to Partner on Technology Joint Venture to Advance More Affordable, High-Quality Healthcare

Digital health vendor K Health, insurer Anthem, and investment firm Blackstone form Hydrogen Health, which will use K Health’s AI technology to develop solutions for consumers, employers, and insurers.

Coding to Hide Health Prices from Web Searches Is Barred by Regulators

HHS tells hospitals to stop hiding their federally required pricing transparency information by adding website code to make it invisible to web searches.

CHIME And HLTH Announce Launch Of ViVE, The New Digital Health Industry Event

CHIME will integrate its Spring Forum into Vive, an annual health IT event it will co-host with the HLTH conference beginning next March in Miami Beach.

News 4/16/21

April 15, 2021 News 2 Comments

Top News

Mayo Clinic launches Remote Diagnostics and Management Platform, which offers AI-powered algorithms and care protocols to help clinicians deliver care remotely.

Mayo also formed two portfolio companies with partners to support its efforts: Anumana (digital sensor diagnostics analysis) and Lucem Health (connecting remote patient telemetry devices with algorithms and for integrating insights into clinical workflow).

The companies raised Series A funding rounds in conjunction with the announcement of $25.7 million and $6 million, respectively.

Mayo Clinic Platform President John Halamka, MD says he expects its work to generate other algorithm companies as society moves from episodic care to continuous care using signals, data, and AI.

In unrelated news, John is wearing a blue dress shirt, tie, and round black glasses in the video above, sporting some new personal branding after decades of the black jacket / black tee combo with wire frames. 


Reader Comments

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From History Reader: “Re: healthcare IT company names. I’ve been trying to remember the one named after a lizard and I’m stumped.” That would be Axolotl, the HIE platform vendor that was acquired in 2011 by UnitedHealth Group-owned Ingenix, which was later rolled up with several other divisions under the Optum nameplate. It was one of my favorite names and made for some fun HIMSS conference giveaways.

From Clicker Quicker: “Re: sponsors. What have you changed to attract the support of new companies?” I haven’t changed much of anything in my nearly 18 years of writing HIStalk. I just keep showing up, which in life is often enough to beat the competition. But health IT has a lot of new, well-funded digital health players who are anxious to gain a toehold and thus come a-calling. The herd-thinning that I would have predicted a year ago due to vendor consolidation was more than offset by this creation of new digital health subcategories. I haven’t seen this much vendor activity since the early days of Meaningful Use, when the investment amounts featured fewer zeroes.

From WebinAren’ts: “Re: webinars. How do sites guarantee the number of attendees? Been wondering that.” Beats me, since attendee count will be driven by the topic, abstract, presenters, and the annoyance level of the signup page, none of which are controlled by whoever is promoting the webinar. Although a chief marketing officer told me once that they advertised with an organization that guaranteed high number of leads, drew a tiny fraction of that as webinar attendees, and then were just given a bunch of random names that had been dumped from a different database to make up the difference, which hardly counts as a lead.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Sonifi Health. The Sioux Falls, SD-based personalized patient engagement company offers the technology and service platform for a smarter hospital: interactive TV with a mobile solution, streaming to patient room TVs using personal devices and subscriptions, digital whiteboards with staff information and patient goals, EHR-powered digital door signs, digital signage for public or staff spaces, and an interactive patient status board. These provide a better patient experience, deliver patient education, and improve quality and safety. The company provides a complete solution, using the client’s existing infrastructure to deliver a white-label solution to hospitals, cancer centers, ambulatory clinics, outpatient surgery centers, post-acute rehab facilities, and senior living / LTC facilities in serving 500 million end users annually around the world with 600 employees, 200 field technicians, and a 24/7 US-based call center. Clients include Stanford Health Care, University of Florida Health, Cedars Sinai, Texas Health Resources, and Adventist Health. The company offers integration with 30 systems, including Epic, Cerner, Meditech, Hillrom, Healthwise, Vocera, Cbord, Staywell, and Elsevier. Thanks to Sonifi Health for supporting HIStalk.

I found this Sonifi Health overview on YouTube.


Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

UnitedHealth Group posts Q1 results: revenue up 9%, adjusted EPS $5.31 versus $3.72, beating Wall Street estimates for both. The company’s market capitalization is $369 billion.

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Boston-based 1upHealth raises $25 million in a Series B funding round. The 70-employee company offers a FHIR API solution for patient and provider connectivity for payers (EHR integration, population health analytics, member data access); providers (aggregating data  from external sources, clinical trials support, patient-facing applications, payer integration, and medical research); and app developers (EHR-connected SMART tools, cost billing, and clinical trials recruitment).

NantHealth obtains $137 million in financing from existing investors. NH shares dropped 12% on the news, valuing the Patrick Soon-Shiong-controlled company at $289 million.

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Jay Parkinson, MD, MPH announces in a blog post that Crossover Health shut down Sherpaa — the virtual primary care and technology company he founded and then sold to Crossover two years ago — at the end of last year. Parkinson has left Crossover, saying that he was too early with Sherpaa, he is burned out, and he is frustrated at seeing newer companies use his ideas to raise large amounts of investor cash. I’m not sure what happened to Hello Health and Myca, EHR-related vendors with which he was once associated.

The Santa Barbara, CA newspaper profiles local tech firm Evidation Health, whose platform monitors a user’s health data to send nudges. The company’s most recent funding round values it at more than $1 billion. The company lists five co-founders among its eight-member executive team, which is surely a record.


Sales

  • University of California Health extends its Sectra Enterprise Imaging solution with VNA, universal viewer, and worklist manager.
  • St. Joseph’s Healthcare Hamilton selects Spok Go for secure digital communication and will collaborate with the company as a development partner, initially to optimize on-call scheduling.  
  • Edward-Elmhurst Health will work with Impact Advisors on innovation, business process optimization, and information services. Both organizations are headquartered in Naperville, IL.
  • SIU Medicine chooses Emerge ChartScout, ChartSearch, and ChartGenie to create a consolidated, searchable database that harmonizes disparate EMR data.

People

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Loyal promotes Steph Geissinger to chief customer officer.

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I missed this earlier: SOC Telemed promoted President John Kalix to CEO went it went public via SPAC late last year. Former CEO and long-time industry investor Steve Shulman moved to board chair.

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Senior independent living company InnovAge hires Alice Raia, MSM (Kaiser Permanente) as CIO.


Announcements and Implementations

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Digital health vendor K Health, insurer Anthem, and investment firm Blackstone form Hydrogen Health, which will use K Health’s AI technology to develop solutions for consumers, employers, and insurers. K Health co-founder and CEO Allon Bloch, MBA will additionally serve as the new company’s CEO.

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EClinicalWorks announces implementation of its Vaccine Administration Management Solution, which is supporting COVID-19 vaccine administration in 29 states, with online appointment booking, patient reminders, contactless check-in, documentation, data transmission to vaccine registries, and inventory management.

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Investor-owned hospital operator LifePoint Health and patient management software vendor Eon sign a five-year deal to develop Healthy Person Program, which will focus on early disease detection, timely notification to providers of findings and patients, and improved patient follow-up, starting with aortic aneurysms. Eon emphasizes use of its computational linguistics models to capture incidental findings, which it says is the #1 way to boost hospital earnings by keeping patients within the system. Founder and co-CEO Akrum Al-Zubaidi, DO is a pulmonologist who founded lung cancer screening technology company Matrix Analytics in 2014, which was renamed Eon in 2018. 

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CHIME, which recently ended its participation in the HIMSS conference, partners with the HLTH conference to offer Vive, an annual “reimagined health technology event” whose first conference will be held March 6-9, 2022 in Miami Beach. It will offer digital health innovation content, CHIME’s Spring Forum, an exhibit hall, and a matchmaking program that pairs potential buyer attendees with vendors. Some of the 18 title sponsors are also exhibiting at HIMSS21, but notable companies that will be only at Vive, at least according to HIMSS21’s exhibitor list so far, include Allscripts, Cerner, and Meditech. In an interesting adjacency of time and space, Vive will convene eight days before and 230 miles away from HIMSS22 in Orlando.


Government and Politics

The VA reaffirms that it will not bring its second Cerner site live in Columbus, OH until it has completed a strategic review of the project and shared the results with Congress, following concerns from users at the first site in Spokane, WA.

HHS tells hospitals to stop hiding their federally required pricing transparency information by adding website code to make it invisible to web searches.


COVID-19

CDC reports that 48% of the eligible US population has received at least one dose of COVID-19 vaccine and 30% are fully vaccinated. US cases, hospitalizations, and deaths are trending up.

CDC’s independent immunization review group declines to make a recommendation on the use of Johnson & Johnson’s COVID-19 vaccine, which was paused this week after reports that six people developed severe clotting problems shortly after being vaccinated. Some committee members said they didn’t have enough information to make a recommendation or to suggest that the vaccine’s use be limited to certain populations. Experts say the group’s lack of action not only leaves J&J’s vaccine on the sidelines for what could be weeks, it also impacts vulnerable populations for whom the one-shot vaccine is their best hope of gaining COVID-19 protection. Still, observers expect the delay to last just a few days, with the more significant damage being vaccine hesitancy that is specific to the J&J product.

Moderna plans to make a COVID-19 vaccine booster shot available by fall, offering a third shot that will protect people from variants going into the fall and winter season.


Other

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CHIME opens its Digital Health Most Wired survey. My early experience of multiple years of participating in (and winning) Most Wired before CHIME took it over in 2017 was that it was a kind of breezy and thus not something I found particularly brag-worthy, but a look at the 44-page, highly in-depth survey instrument shows that earning a high level of certification is a bigger deal than before.

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Harvard Pilgrim, Kaiser Permanente, and Priority Health disclose enrollment numbers for their lower-cost, telehealth-first plans. Harvard Pilgrim sold one group account out of 60 pitched, KP of the Mid-Atlantic States expects 1,000 members, and Priority Health enrolled 5,000 members, 2,000 of whom switched from another of its policies. They note the challenges involved in offering telehealth-first health insurance:

  • It may not be a good choice for people with limited mobile device access or poor Internet connectivity or data plans that can’t support video visits.
  • Users need to be technically comfortable with updating apps and clinically comfortable taking their medical visits online.
  • Healthcare.gov and other marketplaces don’t provide enough space to fully describe how telehealth-first plans work.
  • New enrollees need to be contacted to make sure they understand what their plan involves and how to choose a new PCP.
  • Health plans that try to launch their own telehealth service will be slowed down by individual state licensing for insurers and providers.
  • Harvard Pilgrim and Priority Health partnered with Doctor On Demand, while KP developed its own program using its existing technologies and telehealth-comfortable clinicians.

Sponsor Updates

  • EClinicalWorks publishes a podcast titled “Strengthening Patient Engagement During a Pandemic.”
  • Ingenious Med publishes a new white paper, “How to Minimize Physician Burnout and Optimize Revenues: Lessons Learned from the Pandemic.”
  • CHIME honors Ellkay CIO Marc Probst with its “CIO of the Year” award.
  • Change Healthcare stockholders approve the previously announced combination with UnitedHealth Group’s OptumInsight.
  • Healthcare Triangle partners with CareTech Solutions to offer Meditech customers hosting solutions and managed services.
  • Everbridge wins 2021 Comparably Awards for best company outlook, best global culture, best sales team, and best place to work.
  • Healthcare Growth Partners publishes “Health IT Q1 2021 Insights.”
  • Healthwise partners with accounting and advisory firm Frazier & Deeter in a pilot program that will help HITRUST improve its assessment process.
  • Healthcare IT Leaders, BD, and TrackMySolutions delivered COVID-19 testing for sports marketing firm IMG during Masters week.
  • Impact Advisors will partner with nearby Edward-Elmhurst Health on innovation and transformation, business process optimization, and information services.
  • LexisNexis Risk Solutions wins several Cybersecurity Excellence Awards.
  • Meditech places among the top large vendors in a new KLAS report, “Vendor Performance in Response to the COVID-19 Crisis.”
  • Microsoft adds NextGate’s Enterprise Master Patient Index to its Azure Marketplace.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 4/15/21

April 15, 2021 Dr. Jayne No Comments

It’s a good day to be a clinical informaticist when you can put your knowledge to work and try to help people understand complex clinical topics. The recent pause in administration of the Johnson & Johnson COVID-19 vaccine made today one of those days.

I put on my statistics hat and was able to deliver a quick educational webinar for one of my clients, helping the team understand the reason for the pause and what is being done to better understand the situation. The reported blood clots are cerebral venous sinus thromboses and present with low platelets in addition to the clot. They have occurred in women aged 18 to 48 within two weeks of vaccination, so we should be able to look at administration data to watch those patients more closely. Should our clinicians suspect one of these potentially vaccine-related clots, the treatment is significantly different than that for a “regular” blood clot, so we’re starting to talk about clinical decision support tools to make sure physicians check vaccine status before giving a potentially harmful drug. For my family members who don’t understand what I do when I’m not “being a regular doctor,” this is it.

When I sat for my clinical informatics board exam in 2014, a significant part of the potential content was in the realm of public health informatics. If we’ve learned nothing else during the COVID-19 pandemic, it’s that shortchanging funding for public health hasn’t done anyone much good. The Centers for Disease Control and Prevention released annual sexually transmitted disease surveillance data for 2019, and for the sixth straight year, diseases are at an all-time high. More than 2.5 million cases of chlamydia, gonorrhea, and syphilis were reported. Although the CDC data is older, we definitely saw a boom in STDs in 2020 especially during the initial lockdown phases of the pandemic.

It’s clear that “six feet apart” means different things to different people, but it’s always good to see the visits, because it means people are being tested and treated. People underestimate the impact of STDs and their unintended consequences. While syphilis is up 74% from 2015, congenital syphilis (passed from infected mothers to their babies) is up 279%. Understanding the power of data is a big part of what I do and I’m glad to be in clinical informatics.

Since the recent requirement to make hospital pricing data public, there have been allegations that organizations are using code to block pricing data from appearing in web searches. The House Energy and Commerce committee sent a letter earlier this week to the Department of Health and Human Services, asking for strict enforcement of the price transparency rules. The letter includes a citation from a recent analysis that shows more than 3,000 sites using search-blocking code. Given competing priorities, it remains to be seen how quickly any enforcement efforts will unfold. I’ve seen news stories where physicians who violate federal controlled substance rules are hauled out of their offices by the DEA, so seeing hospital administrators being escorted out in handcuffs would make my day.

With the recent regulations requiring release of visit notes to patients, a corresponding article in the Journal of the American Medical Informatics Association was timely. It focused on patient and family experiences after identifying what they perceive as serious errors in visit notes. The data was from a 2016 survey of patients at two academic medical centers, and although it wasn’t recent, many of the principles likely still apply today. The authors found that among more than 8,000 patients who read at least one note, 17% identified at least one mistake. More than 40% of those patients felt the mistake was serious, and 56% contacted their providers. Barriers to reporting perceived mistakes included not knowing how to do so and concerns about being thought of as a troublemaker. Study participants also had the opportunity to provide suggestions and recommendations for how medical centers can partner with patients and families.

Some of the suggestions included making sure that the reporting process is clear; reassuring patients that there will be no retribution; making reporting templates available; normalizing the idea of patient feedback; and otherwise making feedback easier for patients. Other suggestions included creating some kind of sign-off that would show that a patient had read and approved a note, or the ability for patients to easily add an addendum to a note. Given the resistance of physicians and healthcare organizations to releasing notes in the first place, I think it will be some time before there is support for the latter suggestions. Organizations are much more likely to make the reporting process clear or create reporting templates before they will let patients write in their own charts.

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I just finished reading a book about women doing unspeakable and unladylike things. “Women in White Coats” by Olivia Campbell chronicles the lives of some of the first women physicians in the US and the UK during the 1800s. The first female medical students had to endure all kinds of harassment, including being pelted with mud and physically blocked from attending class by their male classmates. Even after earning degrees and entering practice, they encountered landlords who refused to rent office space to them because it was felt their actions were unseemly. Despite the energy spent simply enduring the experience, early women physicians brought new perspectives to medicine, including a focus on public health, hygiene, and educating mothers on how to keep their families healthy. I enjoyed the read and it definitely added perspective to my career, especially since my medical school class was the first in my institution to have more women students than men and my residency class was all women.

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Rideshare service Uber has teamed up with PayPal, Walgreens, and the Local Initiatives Support Group to create the Vaccine Access Fund. The goal is providing free transportation for patients who don’t have the ability to get to a vaccine site. Funds will be directed to local nonprofits who are working to ensure vaccine access.

I have some friends working towards this locally and there are still significant barriers for some patients, including long shifts at work and lack of paid time off. There are also plenty of people juggling multiple jobs and that certainly doesn’t make it any easier. I’ve made jokes about this, but it’s starting to sound more like something that could actually work: a hybrid food truck / vaccine delivery platform. It would be an ideal way to raise interest and could be routed to a different workplace every day. Throw out some lawn chairs and a couple of pop-up shelters and your clients can enjoy sliders while completing their 15-minute observation period. Who’s with me?

Email Dr. Jayne.

Morning Headlines 4/15/21

April 14, 2021 Headlines 1 Comment

NantHealth Secures $137 Million Financing Package

Analytics and technology vendor NantHealth, part of Patrick Soon-Shiong’s NantWorks group of companies, raises $137 million from existing investors.

VA vows to pause EHR rollout at future sites until strategic review is complete

VA officials promise members of the House Veterans Affairs Technology Modernization Subcommittee that the agency will not move forward with further EHR go-lives until a strategic review of its Cerner-based project is completed.

This Startup Raised $25 Million To Liberate Your Healthcare Data In The Cloud

Health data interoperability startup 1UpHealth raises $25 million in a Series B funding round.

Mayo Clinic Launches New Technology Platform Ventures to Revolutionize Diagnostic Medicine

Mayo Clinic launches two new AI-focused companies to support its newly developed Remote Diagnostics and Management Platform.

Readers Write: Mandatory Encounter Notifications Keep Physicians in the Care Huddle

April 14, 2021 Readers Write No Comments

Mandatory Encounter Notifications Keep Physicians in the Care Huddle
By Samit Desai, MD

Samit Desai, MD is chief medical officer of Audacious Inquiry of Baltimore, MD.

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Primary care physicians (PCPs) are often compared to the quarterback of a football team, as they understand all of the players involved. With this knowledge, PCPs can execute a proper game plan for their patients and direct them along the right routes in the care continuum process.

But imagine a quarterback trying to run the offense without any knowledge of what yard line the team is on. That’s often the situation PCPs face when they do not have up-to-date information about their patients.

With accurate, real-time information—such as when patients are admitted to the hospital or discharged—PCPs can make the right play calls to provide more efficient care, keep patients healthy, and reduce hospital readmissions. The Centers for Medicare and Medicaid Services (CMS) recognizes the importance of these “electronic encounter notifications” to such an extent the agency took the extraordinary step of issuing a mandate: hospitals must make admission, discharge, and transfer data available to patient-identified PCPs and other practitioners, as a condition of participation (CoP) in Medicare and Medicaid. Hospitals must meet this specific e-notification requirement by April 30, 2021.

This is good news, although it is not a simple process. I suspect many hospitals wonder if this CoP notification ruling is simply another administrative hurdle without impact. The truth is that accurate encounter notifications will improve care for patients and keep PCPs in the loop, but hospitals need to prepare now.

CMS has valued this information-sharing process and has encouraged notifications and follow up for years, including through the creation of the TCM Billing Code. These notifications, plus provider outreach to patients that can be as simple as a follow-up call, can help reduce readmissions, which in turn lowers costs for everyone. As the industry continues its steady transition to value-based care, there’s been a greater focus from government, health plans, and providers when it comes to providing access to patient data for improved care coordination. PCPs and providers are better informed through more opportunities to walk through patient conditions, debrief on procedures, conduct medication reconciliation, and coordinate any necessary next steps and communications with specialists.

These notification requirements are new for some hospitals, and compliance is not as simple as flipping a switch. Hospitals are burdened with obstacles and must account for other priorities, including updating registration workflows, supporting new EMR configurations, and preparing for regulatory audits.

To meet these challenges and remain eligible to participate in Medicare and Medicaid, hospitals are increasingly looking for an experienced partner who can help navigate federal regulations and provide the technical capabilities required to deliver effective encounter notifications. For the CoP notification requirement to serve its intended purpose, hospitals should evaluate the options available and look for services that support patient-asserted and provider-attributed alerts.

Transitions of care are among the most crucial moments for patients, and we cannot afford to let anyone fall through the cracks. These new CoP requirements are an encouraging development and will ensure that these critical care coordination technologies are available to patients nationwide.

When hospitals and other providers work from the same playbook and share real-time encounter notifications, patients will benefit from better care coordination, tailored follow ups, and improved health outcomes.

Readers Write: A Proactive Engagement Strategy is Key to Building Patient Relationships and Driving Outcomes and Experience

April 14, 2021 Readers Write No Comments

A Proactive Engagement Strategy is Key to Building Patient Relationships and Driving Outcomes and Experience
By Mike Linnert

Mike Linnert, MBA is founder and CEO of SymphonyRM of Palo Alto, CA.

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Each calendar year, we use awareness months to bring attention to different chronic conditions and diseases that affect the lives of millions of people here in the US and around the world. For example, March was National Kidney Month, which highlights the 37 million people in the US – more than 1 in 7 adults – who suffer from chronic kidney disease (CKD). What’s even more alarming: approximately 90% of those with CKD don’t even know they have it. One in 3 American adults is at risk.

CKD is the ninth leading cause of death in the US. Like other chronic conditions, it’s important that we spend time talking about what we, as healthcare innovators and providers, can do to educate those at risk. We need to help those who are suffering manage symptoms and reduce the risk of acute, life-threatening conditions. We also need to increase general awareness of these diseases and their co-morbidities. 

Early awareness and intervention are proven to drive better health outcomes; in fact, early detection is the most effective way to combat CKD.

When we look at the aforementioned statistic – 90% of those with CKD don’t know they have it – the urgency of education and awareness becomes clear. Erkeda DeRouen, MD, a primary care physician and Inlightened expert, reiterates just how critical knowledge can be: “Kidney disease is very important to discuss because it’s one of those ‘silent emergencies,’ what they call ‘silent killers,’ a lot of people think of like heart disease.” According to DeRouen, a lot of people with some degree of CDK can live for years without knowing anything is wrong, given that it doesn’t always have clearly-defined symptoms.

Be proactive with your outreach and communications. Since most patients don’t know they have CKD or potentially other life-threatening conditions, it may be too late by the time they reach out for care. Whether it’s a chronic condition or simply a healthier lifestyle, providers are in a unique position to improve patient awareness about the role they play in their own health, well-being, and outcomes. A well-designed, data-driven engagement strategy that proactively communicates relevant information, such as tips and tricks for eating healthier, can go a long way in furthering their awareness of the conditions for which they are at risk and can drive real change in their own health.

For health systems and providers, one way to do that is through the development and execution of a data-driven engagement strategy. Data and prioritization are key for effective and successful patient engagement. For health systems, it’s not what content a person is likely to consume (think Netflix); rather, it is about the next best action a patient should take for their health and wellness.

Take for example, a patient with several outstanding actions (i.e., Annual Wellness, colonoscopy, cancer screening, glaucoma exam, etc.) that must take place as part of their care journey. How do you effectively reach out to the patient? What’s the most important action for the patient to take right now?

A study from the American Heart Association found that nearly half of patients who received support through a patient engagement tool prior to a cardiology clinic visit had a positive change in their medication therapy compared to less than a third among patients who did not receive the engagement tool. 

The health systems that are able to deliver hyper-relevant and actionable engagement based on data, both during and between encounters, have a great opportunity to drive real impact in reducing the number of Americans at risk of, and suffering from, chronic conditions like chronic kidney disease.

A study conducted by Forrester on behalf of Cedar revealed that more than a quarter of patients switched medical providers because of a poor digital health experience. The research found that in 2020, 28% of patients switched providers because of a poor digital health experience, a 40% increase from 2019.

We can expect these trends to continue as patients expect the convenience of digital healthcare experiences as a result of the pandemic.

Patients’ expectations will continue to evolve as the consumerization of healthcare continues its forward march. As more and more providers and systems recognize the importance of mirroring people’s everyday digital lives, data shows us that patients will make choices to seek healthcare experiences out that fit their lifestyle and meet their expectations. With consumer brands like Amazon expanding their healthcare footprint, the opportunities for patients to seek out the experiences they expect continue to grow.

In order to drive those sought-after experiences, providers and systems should:

  • Be proactive. Don’t wait for patients to come to you for information. With the plethora of rich data and insights available in healthcare today, proactively reach out to and engage patients as their health advisor to guide and activate them towards the care they need.
  • Be clear. If you want to drive patients to take an action, don’t make them guess why you’re reaching out. Be concise and to the point and then make the action easy to complete.
  • Personalize. Personalization extends beyond just email campaigns that include a primary care provider’s name. They have a higher click-through rate than those that are generic or come from the health system, but which channel or medium does each patient prefer to communicate? Will SMS be more effective for some patients? Or perhaps even good old phone calls? What action is the most relevant for the patient now?
  • Prioritize with data. Rather than sending blanket messages to every female patient over the age of 50 about scheduling a mammogram and potentially overwhelming radiology, why not prioritize and reach out to those who are most at risk first? Imagine sending a text message with information on breast health and how they can schedule an appointment directly within the text.

Unfortunately, we cannot wave a wand and make all patients healthy no matter how much we wish we could. What we can do is leverage the technology that we have available – that people are already accustomed to using – to drive awareness about patients’ health and wellness that lead to better outcomes and healthier patient populations. In the process, patients might have an experience that makes them want to stick around.

Morning Headlines 4/14/21

April 13, 2021 Headlines No Comments

Olive Enters the Operating Room with Empiric Health Acquisition

AI solutions vendor Olive acquires Empiric Health, which offers AI-powered surgical analytics software.

Cohere Health Lands Additional $36 Million in Series B Funding

Care coordination and preauthorization software vendor Cohere Health raises $36 million in a Series B round, bringing its total funding to $46 million.

Elliot Lake hospital joining patient record-keeping alliance

Twenty-three hospitals in Northeastern Ontario will implement Meditech Expanse as part of a new record-keeping alliance.

News 4/14/21

April 13, 2021 News 6 Comments

Top News

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AI solutions vendor Olive acquires Empiric Health, which offers AI-powered surgical analytics software.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Loyal. The Atlanta-based healthcare consumer experience company is solely dedicated to the betterment of patient care and is the preferred software solution for improved care utilization among the nation’s leading health systems and hospitals. One of the first companies to offer end-to-end digital and AI-powered solutions spanning the entirety of the patient journey, Loyal makes it easier for patients to access and schedule care they need. Solutions include Connect (intelligent data management), Patient Connect (provider search and scheduling), Guide (chatbot and live chat), and Empower (reviews, star ratings, and comments). Customers include OHSU, Orlando Health, and Piedmont Healthcare. Thanks to Loyal for supporting HIStalk.


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My reaction to Microsoft’s planned acquisition of Nuance for nearly $20 billion:

  • About two-thirds of Nuance’s business involves healthcare, but it also offers virtual assistants to customers ranging from Best Buy to the UK government’s tax collection service and also voice print-powered biometric security.
  • Microsoft is sitting on mountains of cash and seems anxious to spend it in unrelated ways in a bid for growth, having expensively acquired LinkedIn and a videogame company, while failing in its efforts to invest in TikTok or to buy the Discord messaging platform.
  • Microsoft was as late the cloud as it was to the Internet, and catching up to global competitors by acquisition is neither easy nor cheap.
  • Microsoft, Apple, and Samsung had reportedly considered acquiring Nuance in the past but did not make an offer, and the company drew no obvious acquisition interest until Microsoft came along.
  • Microsoft could have paid a lot less for Nuance last year or the year before, suggesting that either Microsoft was desperate to increase the credibility of its recently developed Cloud for Healthcare or that Nuance’s rapid move to the cloud and strong AI story made it more appealing.
  • MSFT previously paid way too much for Skype, LinkedIn, GitHub, Nokia’s smartphone business, and AQuantitative. It will pay 14 times annual revenue for Nuance.
  • It’s not public knowledge what agreements, if any, remain in place for Apple’s use of Nuance technology to power Siri. Apple seems to have quietly gone its own way and may no longer rely on Nuance, but if money still changes hands, having Microsoft as a critical Apple supplier would be awkward.
  • Nuance has a huge healthcare customer base, but it won’t be a slam dunk for Microsoft to sell into it given that many of those customers only run some version of Dragon Medical, don’t have a deep relationship with the company or see its salespeople, and aren’t necessarily prospects for related products. Microsoft obviously priced its offer thinking it can wring more profit out of Nuance, but it’s not clear how it will do that as an occasional healthcare dabbler (see: IBM Watson Health).
  • Microsoft’s previous healthcare failures are embarrassingly legendary — HealthVault, Sentillion, Amalga, Amalga HIS (an unrelated EHR), Amicore, and COVID-19 vaccine management.
  • Was Microsoft primarily looking for a strong healthcare vendor, a strong technology player in cloud and AI, or a leader in speech recognition technology that includes ambient intelligence? It gets all three for its generous acquisition price, but we’ll have to see how it packages the Nuance business and integrates it (Microsoft is usually very good at that). It also keeps Nuance out of the hands of competitors as the preferred computer interface moves to voice.
  • Nuance’s healthcare ubiquity means the best Microsoft can do short term is to not screw the business up or alienate its customers. Otherwise, it’s a very public stage that cuts no slack. At least Microsoft is leaving Nuance CEO Mark Benjamin in charge for continuity, although he had no healthcare experience before taking the job three years ago.

Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Cohere Health raises $36 million in a Series B round, bringing its total funding to $46 million. The startup has developed care coordination and preauthorization software to improve communication and collaboration between providers, payers, and patients.


Sales

  • Value-based kidney care software and services company Strive Health will use NextGate’s Enterprise Master Patient Index.

People

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Kaiser Permanente promotes Diane Comer to chief information technology officer.

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Frank Jennings (Covera Health) joins Castlight Health as SVP and chief sales officer.

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The Sequoia Project hires Alan Swenson (Kno2) as executive director of health data exchange subsidiary Carequality.

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Shaillee Juneja (Lumina Health Partners) joins Divurgent as principal.


Announcements and Implementations

Twenty-three hospitals in northeastern Ontario will implement Meditech Expanse as part of a new record-keeping alliance.

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GetWellNetwork announces GA of GetWell Anywhere, which gives patients the ability to access engagement and educational resources from their mobile devices throughout various care stages and settings.


Government and Politics

Federal News Network digs into the problems VA clinicians have been dealing with during the transition to Cerner Millennium – a process that, despite initial reports of success, has prompted congressional leaders to call for a review before further rollouts are initiated. Users have noted an excessive number of clicks for certain tasks, data migration failures, dropped community care referrals, and needing to use Microsoft Teams to communicate with other users about EHR problems. The House Veterans Affairs Technology Modernization Subcommittee will meet later this week to review the $16 billion, 10-year project.


COVID-19

FDA asks states to temporarily stop using J&J’s COVID-19 vaccine following six reports of women who developed rare blood clots days after being vaccinated, pending CDC’s review of those cases starting Wednesday. Former FDA Scott Gottlieb, MD says consumers shouldn’t be worried since the alert was intended to remind physicians to monitor vaccine recipients more closely and report milder cases they may have been missing. 

A study finds that people who are hospitalized with the B117 coronavirus variant experience outcomes that are no worse than patients infected with other variants, while another study concludes that vaccines seem to be effective against B117.

Salesforce will allow only fully vaccinated employees to return to work in its San Francisco tower, raising questions about vaccine accessibility and the legality of mandating use of a product that has not earned full FDA approval.

China’s disease control director says the country’s self-developed vaccines offer low COVID-19 protection, leading it consider using MRNA vaccines such as those produced by Pfizer and Moderna. The official, who had previously questioned the safety of MRNA vaccines, walked back his comments afterward, saying that he was referring to all vaccines and not those specifically rolled out by China that use a more primitive vaccine platform. Another official says that China is developing its own MRNA-based vaccines.

Former CDC Director Robert Redfield, MD joins the board of Big Ass Fans, which makes unproven coronavirus claims about its $10,000 ionization fans for commercial spaces.


Other

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Google will conduct a user feedback study as it prepares to develop a consumer-facing health record tool similar to Apple’s Health Record app. Three hundred patients are being recruited for the study from Epic customers in Atlanta, Chicago, and Northern California. The search engine company’s last foray into personal health records, Google Health, lasted just three years, shutting down at the end of 2011. As I opined then, “The only model Google knows involves near-universal adoption that gets advertisers salivating, not having a tiny contingent of wellness buffs and savvy chronic disease sufferers using their free online service. Ultimately, Google’s problem is that an awful lot of Americans care about reality TV and celebrity gossip more than their health. They’re more interested in patch-me-up-doc ‘healthcare’ than I-need-to-make-better-choices ‘health’ that requires proactive electronic tools. The most shocking aspect of Google Health’s announcement in 2008 was either that Google hadn’t figured that out or that they thought they could succeed anyway.”

University of Wisconsin – Madison researchers find that use of the e-prescribing transaction type CancelRx increased the percentage of successfully discontinued outpatient prescriptions at UW Health. CancelRx, which was developed by the National Council for Prescription Drug Programs, sends pharmacies an electronic notice via Surescripts to not fill a previously sent prescription, which is then acknowledged by the pharmacy. It prevents meds from being filled or refilled in the case of an allergic reaction, a prescriber error, or a change in patient status. The authors note that few providers use CancelRx. I’ve seen previous implementation reports and a common problem is that since pharmacies are rarely set up to accept CancelRx transactions, provider EHRs require modification to turn the transaction into a fax.


Sponsor Updates

  • Cerner releases a new podcast, “Cerner Health Forum ’21 preview – Improving clinician efficiency and operational excellence.”
  • PerfectServe has placed among the top large vendors in a new KLAS report, “Vendor Performance in Response to the COVID-19 Crisis.”
  • OptimizeRx is named to the Financial Times list of “The Americas Fastest-Growing Companies” list for the second consecutive year.
  • Kyruus joins the Athenahealth Marketplace Program, enabling joint customers to offer seamless online appointment scheduling.
  • Premier joins a dozen organizations in urging HHS Secretary Xavier Becerra to extend the Next Generation ACO Model through 2022 and to create a permanent, full risk ACO option based on the NGACO model.
  • Meditech posts a new podcast titled “Different than a tornado: How Phoebe Putney Health System navigated the disaster response challenges of COVID-19.”
  • PatientBond publishes a white paper titled “Driving COVID-19 Vaccinations Using Healthcare Consumer Psychographic Segmentation: Research Insights and Solutions.”
  • InterSystems makes its IRIS data platform available on AWS Quick Start.

Blog Posts


Contacts

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

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Morning Headlines 4/13/21

April 12, 2021 Headlines No Comments

Microsoft Acquires Nuance for $16 Billion

Microsoft will acquire Nuance for $16 billion in a deal valued at closer to $20 billion, including debt.

Health2047 Spins Out Emergence Healthcare Group to Empower Independent Physician Practices

AMA commercialization subsidiary Health2047 spins out Emergence Healthcare Group, a turnkey practice management and health IT company focused on independent practices.

CloudMD to Acquire Oncidium, One of the Largest Healthcare Providers to the Employer Market in Canada

In Canada, ambulatory health IT company CloudMD acquires workplace healthcare provider Oncidium for $80 million.

Curbside Consult with Dr. Jayne 4/12/21

April 12, 2021 Dr. Jayne 3 Comments

Lots of chatter in the hospital world this week following a recent Washington Post article that said wealthy hospitals were benefiting from COVID-19 provider relief funds. Some of the data coming out of the larger health systems has been pretty stunning, although hospitals claim they are still struggling. The Post published a letter to the editor from American Hospital Association President and CEO Rick Pollack, who alleged that the Post was cherry-picking data and that the original piece didn’t truly reflect the challenges that hospitals are facing.

I don’t disagree that the pandemic wreaked havoc on many healthcare organizations. For others, the availability of relief funds (including those from the Paycheck Protection Program) may have spurred spending in ways not exactly intended by the programs that provided them. Specific to the Paycheck Protection Program, whose funds came in the form of a potentially forgivable loan, there is certainly room to use the funds for things other than paychecks, since the forgiveness terms only require that 60% of the proceeds must be spent on payroll costs. The terms do require that “employee and compensation levels are maintained,” which certainly didn’t happen at my soon-to-be-former employer, who received $5.5 million in PPP funds but furloughed a good portion of the physicians and cut support staff shifts throughout the month of April 2020.

I was personally furloughed for almost two months with zero compensation, which led to some surprise when the local paper reported the company had taken that amount of PPP funding. Business has been booming since May 2020 with COVID-19 testing and an uptick in sick visits, and it didn’t stop the organization from opening additional locations even before it took on investors. Having personally experienced this type of accounting shenanigans (not to mention the absence of a paycheck for a while), I’m not that sympathetic when I see healthcare organizations posting sizable profits, yet crying poor when they’re called out on it. None of the employed nurses I know received raises during the pandemic, even though travel nurses were paid two to three times the typical nursing salary to provide coverage when times were tough. Organizations in my area weren’t generous with hazard pay or overtime, either.

I also find it somewhat questionable that certain health systems are charging administration fees for COVID-19 vaccines they are delivering, despite using mostly volunteer labor to perform the services. Even in the absence of labor and supply costs (since many of the supplies are provided with the vaccines) some of them can’t claim real estate or utility costs since they are using space donated by local businesses and community organizations. I could see some incremental technology costs if they’re needing computers to run the process, and I certainly support charging a fee if they’re paying people to administer the vaccines, but there are just so many elements of the process that feel a little off as the situation unfolds.

The pandemic has brought into focus many of the more unsavory aspects of our profit-driven healthcare non-system in the US. However, I don’t see a lot of forces aligning to try to change things in the short term. We’re still struggling with disparities in accessibility of in-person care, and even with telehealth we’re seeing that the greatest utilization was among patients in affluent or urban areas. A recent study looked at insurance claims for more than six million patients in the US who received coverage through employer-sponsored health plans. The data was drawn from January 2019 through July 2020 and represented nearly 200 employers across all 50 states. Where in-person patient visits declined at the onset of the pandemic, there was a significant (nearly 20 times) increase in telehealth services. Although telehealth didn’t fully offset the missed patient visits, it certainly helped many patients through the worst months.

The study found that the most notable increases in telehealth visits were in counties with low levels of poverty – 48 visits per 10,000 people. In comparison, counties with high levels of poverty averaged 15 visits per 10,000 people. There was also a difference comparing urban to rural areas – 50 versus 31 visits per 10,000 people, respectively. Pediatric virtual visits were also lower than adult visits (50 versus 65 visits per 10,000 people). The US government is trying to mitigate some of these factors, providing funding for increased broadband services to enable telehealth, including the Telehealth Broadband Pilot, which promises $8 million in improve connectivity in Alaska, Michigan, Texas, and West Virginia.

The authors conclude that there is much to be done to better understand the forces impacting telehealth utilization and to assess what the rates and disparities look like in the future. They call for greater reimbursement for telehealth services and updates to clinical guidelines to encourage telehealth practice.

I agree wholeheartedly, and additionally, I’d like to see more focus on how to make physicians successful with telehealth. Prior to the pandemic, the majority of our experience with telehealth was either with relatively minor acute problems, delivered either by large telehealth-specific vendors or through smaller health system pilots, or through facilitated subspecialty consultations where a patient and their “host” provider would consult remotely with a subspecialist, often at a tertiary center. As the pandemic unfolded, we saw the urgent care services delivering more primary care services, such as medication refills, while brick-and-mortar providers began to scale up their telehealth offerings.

Even as the pandemic eased last summer, a number of my colleagues continued to do more telehealth visits than in person, citing lack of personal protective equipment and the risk of infection. Even now that they’re vaccinated, they still haven’t returned to the office, and are delivering more and more primary care services remotely. That’s a dynamic that certainly needs exploration since the compensation models being used for those visits vary dramatically across organizations. I enjoy delivering telehealth care and am about to add virtual primary care to my bag of tricks, so we’ll see how that goes. I plan to offer some pretty non-traditional hours for my visits, so I’m curious to see what kind of patient demographic I attract. I have just about 80 hours of in-person care left on my schedule and am definitely ready for the next adventure.

What does your hospital or health system have to say about its profitability and acceptance of COVID-19 relief funds? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Charlie Harp, CEO, Clinical Architecture

April 12, 2021 Interviews No Comments

Charlie Harp is CEO of Clinical Architecture of Carmel, IN.

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Tell me about yourself and the company.

I have been developing software in healthcare for a little over 30 years. I’ve worked for companies like SmithKline Beecham Clinical Labs, First Databank, Zynx Health, and Covance Central Labs. Back in 2007, I started Clinical Architecture to address what I thought was an unmet need in the healthcare industry, which was doing a good job of managing how information moves, how we deal with terminology, and how we deal with content. It’s designed to enhance the way we support patients in healthcare and look at information.

What are the challenges of using provider-generated data for operational improvement, benchmarking, analytics, and life sciences research?

There’s a handful of issues with the data that we collect in healthcare. If you talk about just standard structured data — and let’s even include unstructured data — one of the big challenges is that every single application in every single facility tends to be its own little silo of terminology. Code systems that are created in these places by the people who work in those places are usually local. They are not always following the best practices in terms of how they are described.

Public health organizations, large IDNs, or payers that go to collect all that information — even if it’s delivered in a standard container, like a CCDA or an HL7 transaction – experience semantic impedance. To be able to utilize all the disparate codes and put them into a common nomenclature or common normative terminology that you can do analytics and BI and all those things on, you’ve got to do work. You’ve got to introduce work to get the data from its original state into something you can use.

The other challenge we have is that if you look at the standards where we ask people to codify things with standard terminologies, not all mappings are created equal. You deal with that “whisper down the lane” effect with structured data, where they might have mapped it to a SNOMED code or an ICD-10 code for delivery through something like a CCDA or FHIR bundle, but there’s a certain amount of uncertainty baked into whether or not they broadened the term, they narrowed the term, or maybe somebody made a mistake and mapped to the wrong term. There is what I call uncalibrated uncertainty when it comes to the structured data.

The other problem we have is that between 60% and 83% of the data we know about a given patient from any place is bound up in unstructured notes. At the end of the day, what the provider relies on is their notes, not necessarily the structured data, because most of them realize that structured data has a lot of uncertainty in it.

What is the role of artificial intelligence in recognizing terminology problems faster and perhaps resolving them faster?

What we do is a form of deterministic artificial intelligence. We’ve trained our product over the last 10 years to understand certain clinical and administrative domains. When it gets a term like “malig neo of the LFT cornea,” our product parses that apart semantically and turns it into an expression — malignant neoplasm of the left cornea. We use that when we are doing things like mapping, so that we can do about 85% of the work.

If things are really terrible, and I’ve seen some really terrible things come through an interface, then obviously you have to pick up the phone. But in that scenario, what you’re dealing with is deterministic artificial intelligence, where a human being, a subject matter expert, has trained a piece of software to think like they do.

Machine learning is really pattern recognizers. They don’t set a course, they just observe something,. I always warn people that there’s a certain lemming effect of machine learning, where people could be doing a lot of wrong things and the machine learning doesn’t know right from wrong. It just knows patterns. When it comes to doing the transformation of data, the challenge is filling in the gaps of what’s not there. Most of the time when somebody’s struggling with mapping something, whether it’s a drug, lab, or condition, the core part of the struggle is there is something missing. There’s not enough information for them to determine where it should land in the target terminology.

Another challenge is that the terminologies that we use for standards are prescriptive. They are pre-coordinated. Somebody sits in a room, and they come up with a term like “Barton’s fracture of the left distal radius.” They say that, and that’s the term. Let’s say that you’re coming from ICD-10, you have Barton’s fracture of the left distal radius, and you’re mapping it to SNOMED. Let’s say that SNOMED doesn’t have laterality for Barton’s fracture. Most systems that we have today can’t handle post-coordination, where they can glue multiple things together and land it in the patient’s instance data. They have no choice but to choose a broader concept, so they choose Barton’s fracture and the other information left by the side of the road.

Even if we had the smartest artificial intelligence platform in the universe, you can’t map to something that doesn’t exist. The way we deal with structured data in terminologies today is that we use these single codes in our standards. If you can’t find an exact match, what do you do?

What are the risks of companies that assume that FHIR solves their interoperability problem only to find that terminology issues are creating incorrect or incomplete information?

FHIR is a great advancement, but it struggles with what a lot of standards struggle with — it’s a snapshot. We are evolving FHIR and we are using FHIR, but if you look at the old ASTM standard, HL7, FHIR, OMOP, or any of these canonical models, it’s good if we can have agreement that these are the elements we are going to share. When you ask me for a lab result, here’s a standard container that I can give to you. It’s less verbose in many ways than some of the things that we did in HL7, especially Version 3, but it does deliver things in a nice package. It’s good for us to have agreement in how we package things up.

The issue with terminology is a lot of these systems that we use in healthcare, in inpatient and in outpatient, have homespun terminologies. There is no way to get around doing this semantic interoperability. For a long time, we didn’t care, because we didn’t try to collect that data and use it in a longitudinal, analytical way.

FHIR is good. I wouldn’t get rid of FHIR. FHIR is a great advancement. It brings us to consensus on how we package things up, what things are important for a particular type of resource. The fact that people are excited about doing it and they are opening up some of these systems to share data in real-time ways that they never did before is pretty cool. But when I get a FHIR resource that describes a lab test, and it’s using the local lab code, problem ID, or drug code, it’s tough to map it to make sense of that data and do something good.

People coming from other industries say, why is it so hard in healthcare? A big part of it is the systems we built and the platforms we are in. That metaphor of fixing a 747 in flight is very true. You can’t go in and just rip the rug out from under a hospital system and expect that everything is going to be OK. It’s an incremental steppingstone of evolution to get where you need to go. People can suggest that we just get away from all these local terminologies, but that’s going to take a decade, easily. If we can get it done, it’s going to take a decade. We just need to have better solutions and better ways of dealing with this interoperability problem.

The other thing, when it comes to semantic interoperability, is that the onus is on the receiver. The people who are pushing data out have already used it. They are pushing it out to someone else because they have to, but they don’t have to suffer the consequences of it not being accurate or complete or not being coded perfectly. At that point, it’s out of their hands. The onus is always on the receiver of the data who wants to use it to make sure that it is usable.

I always request, when I’m doing some kind of a transaction, give me the original data, even if it’s not a standard. The original data is what the provider chose. It’s what the people said. I’m not going through some third party that picked the closest thing they could find in a list of standard terms. You can give me the standard term you think it is. That could help me a lot, because if they are right, I can use it just like that and I’m good to go. Having the original data eliminates some of that hearsay effect.

We have seen this with our product Symedical, where we have data, like say lab data. We saw a code of CA-125 come through Symedical and people mapped it mapped it to calcium. CA-125 is a cancer antigen test. It has nothing to do with calcium. Because Symedical looks at patterns, says, “CA-125 isn’t calcium. It’s a cancer antigen test.” We were able to fix that and put it in front of a human and say, “It came in as calcium, but this is what we think it is” and they were able to correct that. Those are the kinds of things we’re going to have to do.

A lot of people think that doing that mapping of data is a project, but in reality, that’s a lifestyle choice. It’s like mowing your lawn. You can’t just do it once and walk away. It requires somebody to be keeping an eye on that all the time, because the other thing that can happen is people can change a code. It doesn’t happen with the standards, typically, but it happens with proprietary code systems.

Our mission at Clinical Architecture is maximizing the effectiveness of healthcare. A lot of what we do when it comes to machine learning is not necessarily say, “This artificial intelligence will come in and replace what you do.” It’s really saying that this thing will do a lot of the heavy lifting. It will eliminate a majority of the work. But we never suggest that we can eliminate humans from the equation when we are talking about doing this semantic interpretation of what Human A created and what Human B created, because I create a code, it’s local, I have another person map it to a standard, and that standard comes into System B. The first thing that has to happen is the person in System B has to map it to their local code if they want to use it. 

That’s just point-to-point exchange. If I’m pulling data into an aggregation environment and trying to do some kind of analytics on it, it’s probably easier, because if I’m smart, I’ve probably chosen a standard and maybe extended that standard a little bit to accommodate the outliers. But it’s just one of those things where when we start utilizing longitudinal data from multiple sources, having mechanisms in place to look for things that are uncertain and allow me to rule them in and rule them out is going to be a pretty big deal. Also, looking at unstructured data for high-value information that I can use to improve that picture.

The other thing is using things like inferencing logic, where I can take the things that I know about the medical world and look for data that can’t be true and call it into question. I’m not a clinical person, so bear with me, but if I have a  patient who says they are a cardiac hypertroph and they have a procedure that says they have an ejection fraction of 25%, that can’t be true. There are situations it just can’t be true. If I have a patient who is on insulin and has a hemoglobin A1C of 7%, but there’s no mention in their structured medical data that they are diabetic, it might be in the note, but it might not be in the structured data.

We are trying to do things as we enter into this value-based, population health, analytics world. Look at the public health emergency we just dealt with in 2020. Being able to leverage that data in a meaningful, competent way is going to be critical as we continue to move healthcare forward.

Do you have concerns about drug companies aggregating de-identified EHR data from hundreds or thousands of hospitals and then making significant clinical or commercial decisions based on what they see?

Whether it’s the CDC looking at COVID or pharma looking at a particular situation or looking for cohorts to enter into a clinical trial, the first step is getting the structured data, taking whatever the original people entered into the system, and doing a good job of finding the best possible target. 

The other challenge you have is that because mapping is difficult, people don’t want to do it. Or they say, I’m only going to map the top 50, or I’m going to only map these three things I care about. You can’t really think about it that way, because the things that you are not mapping are a mystery to you. You have to try to map everything, even if you only care about 10 things. Mapping everything makes sure that those 10 things aren’t missing, because they could be if you don’t map everything. If you map everything, then at least you’ve got a picture of the data. 

If you have what originally came from the site, then you eliminate that third party that may have mapped it to a standard incorrectly. It’s good to have that data because it gives you hints at what they thought, but having the original data lets you analyze what the original thing said. Take my earlier example where you have Barton’s fracture of the left distal radius. I convert it to SNOMED, it’s Barton’s fracture and I’m going to land that in my data repository as Barton’s fracture. If I have the original term, let’s say terminology on my side has laterality and anatomic location, I can say, they said Barton’s fracture in SNOMED, but when I look at the semantic payload and the words that are in the original term, I’ve got the exact same thing in my database here as a term. It has a different code, but it says exactly the same thing. I can make sure that I’m not losing information in that transaction. Always try to get original data because you run the risk of terminological hearsay.

As a benefit of people who are aggregating data, as opposed to the old episodic way we dealt with healthcare, is that you get a probabilistic cloud of information about John Doe. When you get all that information, you could use machine learning or AI to help essentially reinforce things. It’s kind of like diagnosing a patient, I imagine. I’ve never done it, but you are looking at all this information and you are looking for things that corroborate or things that indicate that maybe this isn’t true. A lot of the time we just pull everything together and slam it into a list of problems and medications. We are still wrapping our heads around this whole notion of time in healthcare data. Healthcare comes from a very episodic place. We have never really sat down and looked at how should we look at longitudinal information when it comes to diseases, drugs, and labs, so that we can look for this flow of evidence that tells us what’s going on. When you start aggregating, it creates opportunities to do that.

We need to make sure that we are thinking about these problems of how we normalize information, how we look for information that’s missing, how we take information — not necessarily the big word salad output of NLP, but how we mine unstructured data — for things we really care about and make sure we’re integrating them into our information that we’re collecting for patients.

We didn’t have the idea of a data steward position in healthcare, but it will evolve as we enter the post-COVID era. We didn’t have a great handle on why and what was happening. The job of a data steward is to periodically have software that tells them “this data doesn’t look right,” so that we are constantly curating and improving the patient data, ideally involving the patient in that process, so we can have more confidence in that data.

I don’t know if people will say this out loud, but we don’t have a huge amount of confidence in our data,  in part because of all that uncertainty. Most people, whether they realize it deliberately or whether it’s just kind of this itch in the back of their brain, wonder if this data is good. Having a data steward function and having mechanisms that are constantly measuring and monitoring the quality of that data can dramatically improve our ability to have data that we can rely on to make better decisions.

Do you have any final thoughts?

This last year has shined a light on how important information is in what we do in healthcare. It’s not more important than taking care of patients, but we can create high-quality, actionable data as a by-product of taking care of patients. We can feed a cycle that allows the software to do a better job of helping providers, public health experts, and researchers be more effective and yield better results. I’m optimistic that we are on a trajectory to get to that place.

Microsoft Acquires Nuance for $16 Billion

April 12, 2021 News No Comments

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Microsoft announced this morning that it will acquire Nuance for $16 billion, a 23% premium over the company’s share price at Friday’s close. The total deal value, including debt, is nearly $20 billion.

Microsoft says the acquisition represents its latest step in advancing an industry-specific cloud strategy. It says the acquisition will double its healthcare total addressable market to $500 billion.

Microsoft CEO Satya Nadella said in the announcement, “Nuance provides the AI layer at the healthcare point of delivery and is a pioneer in the real-world application of enterprise AI. AI is technology’s most important priority, and healthcare is its most urgent application. Together, with our partner ecosystem, we will put advanced AI solutions into the hands of professionals everywhere to drive better decision-making and create more meaningful connections, as we accelerate growth of Microsoft Cloud for Healthcare and Nuance.”

The deal is expected to close by the end of the year.

Morning Headlines 4/12/21

April 11, 2021 Headlines 1 Comment

Orange County Hospital Seeks Divorce From Large Catholic Health System

Hoag Memorial Hospital Presbyterian is attempting to leave the 51-hospital Providence system, saying the chain’s use of Epic to standardize treatments for cost effectiveness often conflicts with the judgment of its clinicians.

Microsoft in advanced talks to buy Nuance for about $16 billion, announcement could come Monday

Insiders say Microsoft will acquire Nuance for $16 billion, making it the company’s second-largest acquisition after its $27 billion purchase of LinkedIn five years ago.

Health and Human Services Awards TeleTracking with Six-Month Task Order for Continued COVID-19 Capacity Reporting

HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term, presumably for another $10 million.

Google is exploring a health record tool for patients

Google is conducting a user feedback study as it prepares to develop a consumer-facing health record tool similar in functionality to Apple’s Health Record app.

Monday Morning Update 4/12/21

April 11, 2021 News 6 Comments

Top News

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US News & World Report highlights the legal efforts of Hoag Memorial Hospital Presbyterian to leave the 51-hospital Providence system, saying the chain’s use of Epic to standardize treatments for cost effectiveness often conflicts with the judgment of Hoag’s clinicians.

A Hoag cardiologist says the hospital can’t set its own treatment choices and instead is “bogged down by a bureaucracy that requires 51 hospitals to vote on it.”

Providence says the hospital knew that collaborative standardization was part of the affiliation deal.

Hoag also says that Providence illegally imposes restrictions on reproductive care by adhering to tenets set by the Catholic church, which controls four of the country’s 10 largest health systems.

Providence doesn’t own the hospital, but appoints a legal majority of its governing body. It says it will allow Hoag to disaffiliate if it pays an undisclosed amount that Hoag says is unreasonable.


HIStalk Announcements and Requests

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Eighty percent of poll respondents have received at least one dose of COVID-19 vaccine, while 95% plan to be vaccinated by HIMSS21.

New poll to your right or here: Which has contributed most to your overall health? Readers who resent the “one best answer from the list” form of a poll (as opposed to a survey or personal interview) will wail about not being able to choose more than one answer, that health factors are inextricable, or that the provided answer choices are subjective, but work with me.


Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Reuters reports that Microsoft is in advanced discussions to acquire Nuance for $16 billion, with an agreement possibly being announced on Monday. The reported offer is $56 per NUAN share, a 23% premium to Friday’s close.

A private equity publication sets the value of KKR’s acquisition of a majority position in Therapy Brands, which sells 19 behavioral health EHR/PM systems, at $1.25 billion.


Sales

  • HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term, presumably for another $10 million.

Announcements and Implementations

Varian and Google Cloud will develop a diagnostic platform for organ segmentation for radiation therapy, training Google’s NAS technology on Varian’s treatment planning image data.

FDA approves GI Genius, an AI-powered tool that highlights possible lesions in real time during colonoscopies.

MIT highlights the work of its Data to AI Lab on Cardea, an open source framework that uses FHIR to connect to EHR data to answer on-the-fly questions, for now focusing on resource allocation. The team notes that hospital decisions are too critical to simply present a black box answer, so Cardea will show the strengths and weaknesses if the model, then allow the user to start over.


COVID-19

CDC reports that 45% of American adults have received at least one dose of COVID-19 vaccine, along with 78% of senior citizens. Slightly interesting is that the three states with the lowest vaccination rates per capita are contiguous and are often challenged in other public health areas – Mississippi, Alabama, and Georgia, with Mississippi in particular being flooded with available vaccine doses that few residents want.

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Hospitals in COVID-overwhelmed Michigan are banning visitors, cancelling elective procedures, and re-implementing pandemic surge plans, as two dozen hospitals have reached 90% capacity and 15% of the state’s hospital beds are housing COVID-19 patients. Six counties in metro Detroit are reporting their highest numbers of COVID-19 patients since the first weeks of the pandemic last year. State health officials received 58 outbreak reports from restaurants and stores in the past week, warning bluntly that “indoor dining is one of the riskiest things you can do.”

Meanwhile, the White House says it won’t surge COVID-19 vaccine supplies to Michigan because population-based distribution is the only fair way to allocate supply, especially since new outbreaks could occur elsewhere.

Pfizer requests that FDA expand the Emergency Use Authorization for its COVID-19 vaccine to those who are 12-15 years old, citing Phase 3 clinical trials data of its effectiveness.

A large study finds that people who have had COVID are 84% less likely to be re-infected over at least seven months.

Early reports showed that few people with chronic respiratory disease were being admitted with COVID-19, leading to speculation that inhaled glucocorticoids might be an effective treatment. A small randomized trial concludes that early administration of inhaled budesonide to COVID-19 patients reduced the need for urgent interventions and reduced recovery time.

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The New York Times profiles 66-year-old Kati Kariko, PhD, whose early messenger RNA work at Penn failed to draw research dollars and resulted in her moving from lab to lab and never earning more than $60,000 as a low-level, untenured PhD whose job was always at risk. Moderna and Pfizer finally took notice and used her technology to develop their COVID-19 vaccines.


Other

In Canada, a man has struggled since January to remove an incorrectly entered drug overdose from his electronic medical record after the real OD patient, who didn’t have ID, gave paramedics a name and birthdate similar to his own. The health authority says it has removed the entry, but Kevin Robinson says that while the overdose no longer appears on his patient portal display, his doctor says they can still see it.

Cape Cod Healthcare (MA) goes through the technical and legal steps that were necessary to accept donations in bitcoin, as requested by a donor who has transferred $800,000 to the hospital in two transactions. The hospital converts the bitcoin to dollars that it banks immediately, concerned that unlike other forms of donations, its value could swing dramatically.


Sponsor Updates

  • PatientBond completes its study on COVID-19 vaccinations.
  • PatientPing publishes a new white paper, “Real-time, Right Partner: How One SNF Chain Uses Real-Time Alerts to Succeed in Value-Based Care.”
  • PerfectServe publishes the complete guide to “Clinical Collaboration Systems for Hospitals.”
  • Pure Storage is a 2021 Customers’ Choice in the “Gartner Peer Insights Voice of the Customer: Distributed File Systems and Object Storage” report.
  • Spirion wins three gold wards in the 2021 Cybersecurity Excellence Awards and four Globee Business Awards in the 2021 Cyber Security Global Excellence Awards.
  • The Chartis Group names Michael Brown (MD Anderson Cancer Center) director in its Oncology Solutions Practice.
  • Vocera earns Cyber Essentials Plus Certification in the United Kingdom.
  • Waystar earns HITRUST CSF Certified status.
  • Wolters Kluwer Health launches the open access journal Otology & Neurotology Open as part of its publishing collaboration with Otology & Neurotology Inc.

Blog Posts


Contacts

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

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Weekender 4/9/21

April 9, 2021 Weekender No Comments

weekender 


Weekly News Recap

  • KKR acquires a majority interest in behavioral health EHR/PM vendor Therapy Brands.
  • Firefly Health raises $40 million.
  • A magazine article questions the claims and effectiveness of behavioral therapy apps.
  • Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca on digital health solutions for disease management.
  • The Indian Health Service seeks help with developing a strategic plan for IT.
  • Bright Health acquires Zipnosis.
  • The federal government’s information blocking and EHR transparency rules take effect.
  • A two-system study of EHR usage finds that ambulatory physicians spend five hours on the EHR for each eight hours of scheduled clinical time.
  • Bank of America acquires AxiaMed.

Best Reader Comments

I can’t believe after all these years I am still downloading summaries from patient visits that tell me nothing I didn’t know before walking in the door. I already know my Rx med, patient medical / surgical history, VS, etc. What I WANT is a summary of what the doc and I discussed because I don’t always remember all the details and occasionally have needed to refer to it. This is NOT what was intended when this whole notion of implementing EHRs (not to mention paying docs for doing that!) was first started. (JT)

Standardize and automate. Do as much of this as you can, and no more. (Brian Too)

I don’t understand why these health insurance + digital whatever always go for the low cost market. In the Firefly Health article, they say their cost is so much lower (doubtful). But I imagine the people who would want a digital insurance care plan are not the same people who are looking for bargain basement health insurance. (IANAL)

In primary care at least, so much easier when the horse brought doc to the house where they stayed until the crisis resolved. The physician was not interrupted at all. As a country doc by training, I knew we were going down a slippery slope when consultants started saying that all patients needed to be in gowns before doc would encounter them. And now, it is all about productivity first rather than quality. (Kevin Hepler)


Watercooler Talk Tidbits

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Readers provided the New York elementary school class of Ms. F with hands-on math kits, from which she created individualized math toolboxes to accommodate COVID-19 requirements. She says, “Thank you so much for donating to my classroom and supporting us for this year and years to come. We use our materials for math on a day to day basis. It truly has helped us transition to a new type of learning. Thank you so much for all of your help. My students are so grateful as well, they are still talking about the kind person who has helped out and donated to us in a time of need. Thank you so much for everything! We appreciate you.”

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The Department of Defense profiles Army Captain Tineisha Nagle, MSN, APRN, who was deployed under a FEMA program to support ICU staff at Yuma Regional Medical Center (AZ). She graduated from the United States Naval Academy with a degree in ocean engineering and then earned bachelor’s and master’s degrees in nursing, served 12 years in the Marines including deployment to Iraq as a lieutenant, and recommissioned to the Army Reserves, where she is completing her first year as a critical care nurse.

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A Minnesota hospital nurse who was fully vaccinated for COVID-19 in January is stuck in quarantine in a Playa del Carmen, Mexico hotel room after testing positive in preparing for her trip back home from vacation. She is restricted to a small room that is guarded around the clock, but at least she bought the hotel’s $30 insurance policy that covers room and meals for 14 days for guests who test positive.

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A Michigan baby who is nearly two years old goes home for the first time, having spent her first 694 days hospitalized in the pediatric cardiothoracic ICU with a congenital heart condition that required four open heart surgeries. It’s probably best to focus on the feel-good aspect and not the size of the University of Michigan bill or who ultimately will pay it.


In Case You Missed It


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Morning Headlines 4/9/21

April 8, 2021 Headlines No Comments

Emids Acquires Quovantis Technologies in Latest Expansion of Human-Centered, Design-Led Product Development and Software Engineering Capabilities

Emids acquires software design and development vendor Quovantis Technologies.

Vesta Healthcare Announces $65M in Growth Capital to Transform Care for High Needs Members and their Caregivers

Vesta Healthcare, which offers clinical services and a digital health platform to support high-needs members and their home caregivers, raises $65 million in growth capital.

MediSolution acquires Quebec-based Intégration Santé

Harris subsidiary MediSolution acquires Quebec-based, MIRTH-focused healthcare integration services vendor Intégration Santé.

Canvas Medical Raises $17 Million to Accelerate Value-Based Care Platform Growth

San Francisco-based EHR vendor Canvas Medical raises $17 million and announces a partnership with Anthem and its providers.

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Reader Comments

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