Recent Articles:

Morning Headlines 4/12/24

April 11, 2024 Headlines No Comments

SAMHSA and ONC Launch the Behavioral Health Information Technology Initiative

ONC and SAMHSA will invest $20 million over the next three years to improve health IT in behavioral health and practice settings through the new Behavioral Health Information Technology Initiative.

VA plans to restart EHR deployments before the end of FY25, secretary says

VA Secretary Denis McDonough says that the department will resume rolling out MHS Genesis before the end of fiscal year 2025, despite the fact that the 2025 budget doesn’t include any funding for additional deployments of the Oracle Health system.

Alcohol Addiction Treatment Firm will be Banned from Disclosing Health Data for Advertising to Settle FTC Charges that It Shared Data Without Consent

The FTC bans virtual alcohol addiction treatment company Monument from sharing patient health data with third-party advertising sites.

News 4/12/24

April 11, 2024 News 5 Comments

Top News

image

Transcarent CEO Glen Tullman launches 62 Ventures, a $100 million venture fund that will focus on healthcare startups in the US and India. Its portfolio already includes BridgeHealthAI (health and social care), Khyaal (senior care), and Loop Health (care management and benefits).

Tullman is also the founder and managing partner of digital health fund 7wireVentures, which has invested in Transcarent and Tullman’s former employer, Livongo.

Tullman oversaw the $18.5 billion sale of Livongo in 2020 to now-struggling Teladoc Health during his tenure as executive chairman.


Reader Comments

From My2Cents: “Re: Epic interoperability. CEOs of technology companies that facilitate data exchange via Carequality claim that Epic has cut off their records requests. I think the issue is that they supposedly were sending data to companies whose Purpose of Use does not involve Treatment, Payment, or Operations (TPO). I wonder if those companies will incur HIPAA fines for knowingly providing inappropriate access to patient records?” Unverified, but being debated on LinkedIn, including by Particle Health founder Troy Bannister. He says that Epic stopped responding to certain medical requests in claiming that the recipients do not directly support treatment, which Bannister denies. Using patient data outside of HIPAA’s TPO definition requires individual patient consent. Also at issue is whether or not providers themselves asked Epic to stop sharing data with companies that they believe were misusing it, in which case Epic has to comply.


Webinars

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


Acquisitions, Funding, Business, and Stock

image

Tower Health (PA) will outsource its revenue cycle operations to Ensemble Health Partners this summer, transitioning 675 employees to the RCM company.


Sales


People

image

Jay Sultan (United Generations Capital) joins Tegria as its first chief data and analytics officer.


Announcements and Implementations

image

Inovalon announces GA of SDOH Market Insights for life sciences companies.


Government and Politics

ONC and SAMHSA will invest $20 million over the next three years to improve health IT in behavioral health and practice settings through the new Behavioral Health Information Technology Initiative.


Other

image

Cedars-Sinai (CA) expands the capabilities of its Connect virtual care app to include pediatric and Spanish-speaking patients. The app, which launched last year, uses technology from K Health.

image

UW Medicine (WA) launches a Cognition in Primary Care program to helps its primary care physicians better manage the care of patients with cognitive issues like dementia. Cognitive care protocols and shortcuts embedded in the health system’s Epic EHR have been especially helpful, according to early adopter Nina Maisterra, MD: “Until it became muscle memory, it was great to refer to dot phrases they built. In primary care, we don’t usually get content that’s this user-friendly.”

New survey findings from the American Medical Association reveal that 51% of physician practices have lost revenue due to an inability to process patient co-pays after the cyberattack on Change Healthcare, while 80% have lost revenue from unpaid claims. Though 55% have had to use personal funds for practice expenses and 31% have been unable to make payroll, only 15% have reduced operating hours.


Sponsor Updates

  • CereCore releases a new podcast, “When Healthcare’s Toughest Problems Need an Outsider’s Perspective.”
  • Sonifi Health expands its support for virtual hospital care with telehealth partnerships and system optimizations.
  • Healthcare Choices NY uses the EClinicalWorks EHR and Healow no-show prediction AI model to reduce its no-show rate, increase revenue, and improve patient care.
  • Morris Hospital and Healthcare Centers (IL) recounts its successful Meditech Expanse implementation and resultant benefits.
  • First Databank names Kristin Buechler clinical informatics pharmacist, Erin Gosney operations manager, and David Morris senior software engineer.
  • FinThrive releases a new Healthcare Rethink Podcast, “How Do You Tailor Healthcare Affordability?”
  • Healthcare IT Leaders releases a new Leader to Leader Podcast, “Cybersecurity and Change Healthcare: Assessing the Impact of a Major Cyberattack.”
  • New research from Inovalon and Harvard analyzes Medicare Advantage plan design’s impact on healthcare utilization and health equity.
  • Black Book Research survey-takers rank Veradigm’s Practice Fusion EHR first in customer satisfaction with ambulatory EHR and practice management software.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 4/11/24

April 11, 2024 Dr. Jayne 1 Comment

I recently saw an article talking about the creation of chief AI officer roles at several organizations. Artificial Intelligence is here to stay and we need to be proactive about its consequences. Politico ran a great article recently that looked at the intersection of AI and medical malpractice. It cites comments from AMA President Jesse Ehrenfeld, who says that lawsuits are already being filed about the use of AI in healthcare. In speaking with some of my friends who are attorneys, they noted that there will be some interesting case law created over the coming years. Tech vendors will be pointing fingers at the clinical end users who leverage AI in patient care, and those practitioners will be pointing their fingers right back at the AI technology’s creators. Physicians are already left holding the bag for a variety of things, including patients who refuse recommended care and patients who get caught in the crossfire when insurers won’t cover recommended care. What’s one more point of liability?

From Madge in HR: “Thanks for mentioning employee handbooks last week. I think the majority of people just sign them blindly and don’t read them. It’s always interesting to me when a company deploys a new policy to the wild, but especially so when you know that the policy is the result of a recent event. My company just announced our new ‘Professional Behavior Policy.’ While it’s shocking to me that we need such a policy in place, it’s reassuring to know that the company values professionalism and is willing to require it of every employee. The prohibited behaviors that stuck out to me included: slamming doors; refusal to communicate or communicating dishonestly about business matters; obstructing, undermining, or preventing another employee’s work performance; and possession of objects that are sexual in nature. Long story short: Be nice to each other. Don’t throw a tantrum. Don’t lie. Don’t keep others down. And for the love of all that’s good and right, keep your bedroom toys out of view when you’re on a Teams meeting.” Although I agree with the intent behind these, I don’t envy those that have to handle complaints on some of the more subjective issues. Most of us have at least some experience at companies where people stretch the truth to varying degrees and where politics and blocking are a daily event. It’s sad given the fact that we’re all in an industry where the ultimate use case is about helping people.

The US Food and Drug Administration has cleared its first AI tool for sepsis detection. Developed by Prenosis, the Sepsis ImmunoScore tool was approved through the FDA’s De Novo pathway. Sepsis is a serious health condition, leading to more than 350,000 deaths annually. The tool looks at more than 20 clinical parameters including vital signs and laboratory results to help identify sepsis risk. Although other organizations, including Johns Hopkins University and Epic have built sepsis detection systems, this is the first one to receive FDA approval. The Prenosis tool sorts patients into four different risk categories but is not considered an alert system. Testing was performed on a dataset that included more than 25,000 patients.

Having spent a good chunk of my career working in emergency department and urgent care settings, a recent article about “rat snacking” really resonated with me. Although the headline was mostly about physicians, the piece applies to anyone whose work schedules disrupt traditional mealtimes. The authors define “rat snacking” as when “people consume whatever type of food they can scavenge.” Anyone who has ever subsisted on graham crackers and apple juice swiped from a hospital unit’s floor stock feels this in their bones. A local hospital recently curtailed the availability of what one nurse describes as “real food” on the night shift, citing cost control measures. Maybe they should be more aware of the literature that shows that disordered eating can lead to nutritional deficits and excess consumption. Of course, the answer is planning ahead and packing your own food, but that only goes so far when your eight-hour shift suddenly becomes 12 or 14.

The Change Healthcare ransomware debacle continues to be a thorn in the side of many physicians, as they await claims and payments to catch up. Several of my local colleagues have had to take out lines of credit or personal loans to cover office payroll and they’re eager to eventually reach resolution with their revenue cycles. Change Healthcare’s parent company, Optum, isn’t winning any friends with recent headlines about practice acquisitions that leave patients without physicians as theirs jump ship. This particular story includes a vignette of a patient who has been part of the practice for more than two decades but cannot be accommodated after the departure of his physician. The patient panels carried by primary care providers these days are more than twice the size of those that existed when I was in a traditional family medicine practice, and those bloated panels make it difficult to recruit replacement physicians.

The happenings going on at this particular organization, Oregon Medical Group, have led to the introduction of legislation designed to slow the influx of corporations into healthcare in the state. The reality of the entry of these parties into the healthcare ecosystem is that their goals are not the same as the owners they replace – often physicians. Where physician-owned organizations will generally continue to participate with low-paying payers, such as Medicaid, many corporate entities move quickly to try to push those patients out of the practice. Non-physician owners that have shareholders are motivated primarily to deliver profit to those shareholders, which can increase provider burnout and place patients at risk.

Given the challenges facing primary care physicians, I was surprised to see the number of medical students who requested to participate in my local medical society’s “Coffee with a Doc” program. I took a first-year medical student to lunch and was surprised to learn that her school is incorporating classes on “the business of medicine” as early as year one. She had some good questions about RVUs and physician payment, and I introduced her to the concept of Direct Primary Care, which apparently wasn’t included in her curriculum. I’m seeing increasing numbers of my family medicine colleagues moving in this direction, so I’m glad the topic came up. Kudos to her school for adding information to the curriculum that can help students learn more specifics about what they’re getting themselves into.

From Stage Mom: “Given your previous comments about health systems sponsoring stadiums and other facilities, I thought you would appreciate this article about a $5.4 million theater naming deal.” BayCare Health System, based in Clearwater, FL, will pay the amount over a 10-year period in exchange for naming rights at the BayCare Sound amphitheater. The agreement has an option for a 10-year renewal in 2034. BayCare also has a ballpark under its belt. According to ChatGPT, that amount of money would pay for more than a quarter million influenza vaccines, or more than a hundred thousand cervical cancer screening tests, or more than 36,000 mammograms. I wonder which the community would rather have?

Will health systems keep slapping their name on everything, or will they start to put their non-profit profits to better use? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/11/24

April 10, 2024 Headlines No Comments

Tower Health and Ensemble Health Partners Announce Strategic Revenue Cycle Partnership

Tower Health (PA) will outsource its revenue cycle operations to Ensemble Health Partners this summer, transitioning 675 employees to the RCM company.

Physicians struggle to keep practices afloat after Change cyberattack

New survey findings from the American Medical Association reveal that 51% of physician practices have lost revenue due to an inability to process patient co-pays after the cyberattack on Change Healthcare, while 80% have lost revenue from unpaid claims.

Bayer and Google Cloud to Accelerate Development of AI-powered Healthcare Applications for Radiologists

Bayer and Google Cloud will collaborate on developing AI solutions for radiologists.

Healthcare AI News 4/10/24

News

image

Google opens Gemini 1.5 Pro to developer preview via API, which includes native speech understanding and a file handling API. The system was tested with a 400-page transcript from the Apollo 11 mission, about which it could answer questions and details from conversations and images using up to 1 million tokens.

Meta says it will release its Llama 3 open source LLM within one month, with double the parameter size of Version 2 and about the same as Open AI’s GPT-4.


Business

Bayer and Google Cloud will collaborate on developing AI solutions for radiologists.

Northwestern Medicine and Dell’s AI Innovation Lab create an LLM solution for drafting x-ray reports. They are also working on a predictive model for the EHR.

All of India’s major hospital chains are using AI, with Apollo Hospitals testing it for patient monitoring, cardiovascular disease prediction, symptom checking, radiology workflow, and in-room automation. Apollo says that some of the technologies have earned US FDA clearance.


Research

image

Researchers document the steps that were involved in Duke University Health System’s design, development, and maintenance of the AI-powered SepsisWatch system. They hope to illustrate the lessons that were learned in developing algorithms, involving stakeholders, and setting up an organizational structure.

Researchers find that an algorithm can predict hospital-acquired pressure injury with 74% accuracy, extending EHR-calculated Braden Scales into an early warning system that could save a 500-bed hospital up to 90,000 labor hours and $18 million in expense each year.


Other

image image

Penn’s medical school names Marylyn Ritchie, PhD, former director of biomedical informatics, its first vice dean of AI and computing. University of Pennsylvania Health System also promotes former radiology chief Mitchell Schnall, MD, PhD to SVP of data and technology solutions, with a focus on AI.

International health leaders list four action areas that should be addressed to fully realize AI’s healthcare potential:

  • Identify high-priority data elements that are needed for AI applications and ensure that availability of those elements is reliable.
  • Test AI tools to ensure that they are safe and effective within specific patient populations and are free of bias.
  • Standardize business processes so that data can be shared between institutions, such as connecting encounter data to outcomes, and explore privacy-preserving data sharing approaches.
  • Advocate for paying for value (quality, safety, health, and costs) to align the financial incentives for using AI.

Contacts

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

Readers Write: Payment Card Fees Explained

April 10, 2024 Readers Write No Comments

Payment Card Fees Explained
By Heather Randall, PhD

Heather Randall, PhD is chief compliance officer of TrustCommerce, a Sphere company.

image

The recent comments from HSA Card User and Mr. H on 3/11/24 shine a light on an increasingly common trend on the addition of fees to your invoice, restaurant bill, sporting event, concert, or medical bill. Many businesses are adding new fees in an attempt to cover their operational costs, which continue to increase. These fees can be frustrating for consumers, and if not done in compliance with the Card Brand Operating Rules, can actually expose businesses that are trying to incorporate these fees to fines and penalties.

When discussing card fees, it is important to understand that there are different fees, and card brands maintain different rules for each type of card fee. For example, these three types of fees each have a different purpose.

  • Convenience fee. A charge that is added when the business offers the cardholder an alternative payment channel that is, in fact, a convenience. For instance, a healthcare practice may accept payments in office, but may offer patients the ability to pay online. In that case, the ability to pay online is considered a convenience and a fee may be added to that payment channel. Convenience fees may not be charged in a face-to-face transaction or by a business that operates solely online.
  • Service fee. A fee that is charged by a merchant or entity in the government or education sector, or a processor that enables payments for such a merchant. The merchant must pass a special identifying value in the transaction message to validate that it is eligible to charge such a fee. Such merchants may include municipal utility providers, tax assessment offices, registrar’s offices, and similar entities.
  • Surcharge. A surcharge is a fee that is added to a total invoice amount to cover the entity’s cost of processing the transaction. Surcharges are capped at a certain percentage by the card brands and some states. In addition, there are a handful of states in which surcharges are illegal, and several others in which there are significant regulatory requirements around how a surcharge is to be implemented and communicated. Surcharges cannot be charged on a debit card transaction.

Another important note is that an organization can only charge one of these fees, depending on the card brand. For example, if a patient is paying a medical bill through a portal, the practice can charge either a convenience fee or a surcharge, but not both.

Surcharging in particular is a nuanced process. Maintaining balance between the different card brand approaches to compliant surcharging — and cash discounting, which is also an emerging trend — and state laws is tricky at best. This is particularly true given the recent settlement between Visa/Mastercard and several merchant groups. That settlement included some changes to the ways in which surcharge will be managed by the brands. It remains to be seen what the impact of that settlement will be on the practical realities of imposing such a fee.

The long and the short of it is that merchants can use a number of fees to offset the costs of operations, but they must be used in a way that is compliant with state laws and industry rules. Doing so can be extremely complicated and can court significant consequence if not implemented correctly. Any business investigating leveraging convenience fees, service fees, or surcharges is well advised to speak with their merchant service provider or acquirer before implementation.

Readers Write: Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores

April 10, 2024 Readers Write No Comments

Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores
By Sherilyn Giauque

Sherilyn Giauque is principal product manager at AdvancedMD of South Jordan, UT.

image

By reducing wait times, healthcare providers elevate the patient experience and improve healthcare outcomes, while also driving greater efficiencies across the practice. 

The amount of time a patient spends waiting to see a healthcare provider has a direct impact on the patient’s perception of the practice and level of care they receive. The longer a patient spends waiting — either to schedule an appointment or to see their healthcare provider once they arrive at the practice — the more likely they are to seek out a new physician or simply stop receiving care. 

When scheduling an appointment, the average wait time to get into a medical office is 26 days. That means that many patients are waiting nearly a month just to see their healthcare provider. Research conducted by Duke Health revealed that every 10 minutes that a patient spent waiting to see their healthcare provider led to a 3% decrease in patient satisfaction scores. 

If you’re searching for new ways to build a patient-centric practice that prioritizes patient care and outcomes above all else, here are five tactics that can help you reduce the amount of time your patients spend waiting to see you. 

#1: Take a strategic approach when managing waitlists that minimizes the impact of no-shows while optimizing daily schedules 

Double-booking and triple-booking appointments with high no-show rates can help eliminate unnecessary downtime for both the admin and clinical staff while keeping your practice operating at full capacity. Be sure that waitlists can be easily accessed and updated by your admin team, with automated notifications built in to alert patients when an appointment slot becomes available. 

#2: Give patients access to digital intake forms that can be completed online to streamline patient check-in processes

By taking advantage of digital intake forms, your practice can eliminate the need for patients to fill out paperwork while waiting to be seen. Online forms also help reduce errors and minimize the amount of time your admin team spends entering patient data—all while providing a smooth patient experience. 

#3: Take advantage of a unified medical office software platform that includes integrative EHR, practice management, and patient engagement solutions

Now more than ever, practices need highly integrative technology solutions that seamlessly connect all sides of the business. An effective all-in-one EHR, practice management, and patient engagement platform comes equipped with key features that can help reduce wait times, including: internal wait-list management capabilities, rooming features to move patients through the office as quickly and efficiently as possible, automated appointment reminders, and customizable intake form templates.

#4: Allow patients to schedule visits and manage their healthcare experience via intuitive self-service tools

Patients who have more control over their healthcare experience and more flexibility when it comes to scheduling appointments tend to be more satisfied with their healthcare providers. Providing your patients with self-service tools and access to an online portal where they can access billing records, make payments, schedule appointments, and review lab results not only streamlines patient-centric workflows, it helps reduce workloads and improves the entire patient journey, shrinking wait times and improving patient satisfaction. 

#5: Prioritize onboarding programs for new staff and keep employees well-trained on the practice’s technology stack and workflow best practices

Making sure your staff understands best practices around workflow processes and is up to date on your technology solutions is key to building a thriving, patient-centric practice. Taking the time to properly train both admin and clinical staff enables efficiencies throughout the practice, removing bottlenecks and ensuring smooth transitions as patients move from a waiting room, to an exam room, to the checkout desk. 

The reality is that long wait times are not only detrimental to the patient experience, they can be devastating for anyone who is suffering from a chronic illness who is in need of prescriptions or advanced treatment programs that require accelerated timelines. Improving wait times not only elevates the patient experience and improves healthcare outcomes, it has a positive effect on your entire practice, driving efficiencies throughout the office.

HIStalk Interviews Paula Scariati, DO, Physician Informaticist and Author

April 10, 2024 Interviews No Comments

Paula Scariati, DO, MPH, MS is a physician informaticist, EHR governance consultant, and author of the book “EHR Governance: A Practical Guide to User Centric, Consensus Driven Optimization.”

image

image

Tell me about yourself and what you do.

I’m an preventive medicine and public health doctor. I fell in love with the promise of what technology could do to make patient care and access better, so much so that I left the private practice that I had in San Diego 15 years ago to formally retrain in informatics.

But nothing that I learned in my academic studies really prepared me for my first job as a physician informaticist in a large, enterprise healthcare system. Providers were frustrated by poorly designed software, inefficient workflows, and low-value tasks. EHR governance was immature, and was often driven by well-meaning executives who didn’t really use the EHR. End-user requests were low priority and frequently lost to follow up.

In short, the processes were slow, poorly coordinated, and had lots of bumps, detours, and do-overs. It was intense. The tipping point came when a large region that was part of the enterprise threatened to return to paper, and there was a crisis. Out of that crisis, a methodical, user-centric, Agile approach to EHR governance was born.

How has EHR governance changed now that most health systems have chosen and implemented an EHR?

Governance has matured organically over time. In the beginning, back when most organizations went live, it usually meant that a process was stood up at the end of go-live, where that critical mass of requests that were made during go-live, but not necessarily addressed during go-live, were handed over into a queue.  That was the focus of early governance work, the robust adoption of a new system with well -integrated workflows.

But once those I’s were dotted and T’s were crossed, the focus of governance then shifted to optimization. That work included end users adopting new tools and refining interfaces. This organization was looking for more effective, efficient care. It took probably several years for that to unfold. 

Then the organization moved on to the next phase of EHR governance, which I call transformation. It’s at that point where the organization’s governance framework would be well established and trusted. It has become part of the cultural norm of organization. There’s now a pathway, hopefully an Agile pathway, for conducting pilots or proof of concepts, which allows the organizations to quickly vet new technologies, modules, and features. There’s also an established system for communicating and socializing change.

I’d like to believe that over these last 15 years, many organizations have found a level of transformational maturity in their EHR governance processes that works well for their healthcare system and their culture. However, I’ve also spoken with so many leaders and organizations where EHR governance never got a strong footing, or where well-designed governance processes were fouled by mergers and acquisitions or major leadership changes.

Do health systems incorporate the participation of medical staff technology naysayers in addition to the “friendlies” who will reliably support most executive decisions?

EHR governance needs to be led, and it needs to be led by somebody who is well respected and has the power to make changes when they need to. That right person needs to be embedded in a consensus-driven governance process. That process needs to listen closely to everybody. People who say they’re doing a good job, but especially the people who tell them that they are not.

Sometimes that negative feedback is more representative of the truth. Sometimes it isn’t representative at all, but it’s the canary in the coal mine, meaning that that person has the unique ability to see a real problem before others do. Occasionally, it might be a disruptor who has a less-than-kind intention, who can in good faith be ignored. 

But it is important to remember that a solid EHR governance structure is a two-way street. Communication goes out, but communication also comes back in. You need to be listening to the voice of the end user. Because when that is done well, a responsive governance process can throttle and balance an organization between that need for change and that problem with inertia or the status quo. Every organization has a different level of tolerance. A good system will recognize that and reduce the amount of fatigue and burnout that an organization will have because it is keeping to close on what’s going on.

Early EHR decisions were often made without thorough physician involvement, or by departments that wanted to make their own jobs easier by using the EHR to push more work onto physicians. Are some of those decisions being revisited or are physicians being asked directly how the EHR hurts or could help their work?

I think it’s safe to say that every organization that adopted an EHR back in 2009, which is when HITECH was enacted ,would have been thrilled if the software was mature and user friendly. But we have to remember that every vendor’s core EHR product was initially designed to meet Meaningful Use metrics, and that went on for seven years. Nowhere in there was a mandate for the user interface to be friendly or for the user experience to good. 

That exists even today. Our former Meaningful Use metrics have now morphed into the Promoting Interoperability Programs and eCQMs. This is all the basis for driving value-based care, but it took a number of years for that emerging body of literature on the unintended consequences of EHRs, note bloat, provider fatigue, and burnout to elevate the importance of the end-user experience and push it to the forefront. Physicians were rightfully frustrated and local decisions were made, decisions were made by the vendors, but they weren’t made with the idea of how to improve the user experience. They were made, how do we meet this metric? How do make this quality metric or safety metric get reported so that we can obtain Meaningful Use dollars? 

There was also a lot of frustration on the part of physicians because they were now being asked to play well with others in the sandbox. They were asked work with their colleagues and other teams to come to a consensus on how to design their user interfaces and workflows. This was a difficult task for some specialties, such as cardiothoracic surgeons who might be used to having their own unique way of doing things. This is where having fair, transparent, equitable governance processes is incredibly helpful. It levels the playing field and it sets consistent expectations.

Physicians are just about the only professionals who are expected to enter data into a computer system while doing their jobs, and often the data that they are recording doesn’t benefit them or their patient directly. Is AI or the use of scribes likely to change that?

Forcing physicians to become data entry clerks has been one of the greatest failings of EHR adoption process being driven by Meaningful Use. AI will get the keyboard off the physician’s lap, which will go a long way toward restoring the doctor-patient relationship. In fact, the highlight of HIMSS24 was the latest iteration of ambient voice technology married to artificial intelligence. These types of software capture the doctor-patient encounter verbatim and then use AI -driven logic to digest that information into a succinct, readable node. It’s amazing, and I think it’s just the beginning of what AI that is thoughtfully utilized in healthcare can do. 

However, there’s a lot of pressure on AI to solve all the problems that we have. It would be very nice if it can do that. I’m waiting and hoping that that will be the case. Some people say five years. I am a big fan of following Eric Topol’s voice in the matter, and I think he’s more optimistic than most in terms of how quickly this will unfold. But either way, I think it’s going to go a long way to help correct a lot of the problems that we’ve encountered as a result of how our initial work with EHRs has happened over the last 15 years.

How does the art of medicine coexist with the use of technology to standardize processes and guide medical decision-making?

When we first started digitizing medical records, a good deal of folly took what was on paper and just made it digital. We didn’t really use the knowledge that we had of how to make the EHR better, stronger, and faster than paper ever could be. But now, we see that the science underlying medicine grows exponentially every day. Just look how much medical literature is published each day. Then there’s the patient’s genomic data and now their phenomic data and so much more. It is absolutely impossible for any one provider or provider team to keep pace without using electronic tools that can securely capture, store, and make some good sense of it all.

What I see on the horizon is that good clinical decision support tools and analytics are going to expand the horizon of the physician. But the road to getting there is going be bumpy. We haven’t really taught our physicians or given them tools in a way that are user friendly. That’s where governance comes in, helping us to figure out how much we can change, how quickly we change, and vetting stuff ahead of time so that we determine what kinds of problems it may have and then deploy it using that group of early adopters who likes to do that type of initial pilot or proof of concept work, and help them to become the agents of change within our organizations.

Epic’s implementation model involves a rigid methodology and the assumption that C-level hospital executives will follow the recommendations of vendor employees who might have been sitting in a college classroom a year or two before. Did that level of prescriptive vendor involvement change the way that hospitals implement technology?

I gave a talk yesterday and user experience with Epic.The takeaway is simple — incentivized behavior change is more effective, and Epic was very smart. Early on, they recognized that organizations didn’t know what they didn’t know, and so they led. They were prescriptive. They trained and deployed resources. They didn’t nickel and dime their customers, but the level of support that came with them had a larger price tag and, in the end, better customer satisfaction. I’ve spoken with a number of organizational leaders that have used Epic and other EHRs, and they consistently they tell me that they find the Epic model to offer added value.

The takeaway is that incentivizing behavior change, being prescriptive — especially in an environment where people are learning something new, where they don’t know what they don t know — is a valuable way to deploy something. 

Is governance different in Epic-using health systems, either because they are self-selected as large, academic medical centers or because they are influenced by Epic or its other customers?

Epic had its origins in the ambulatory world. A number of Epic installations are organizations that have brought together large groups of ambulatory providers. We used to call the ambulatory world the wild, wild West, because in the inpatient world, a large, complex go-live has a lot of moving parts, while the ambulatory world, each individual practice has its own way of doing things. When you try to bring that together under a governance structure, it’s a little bit more challenging to get people to talk to each other or get them to agree on a certain interface or workflow.

In my experience, maybe not in everybody’s experience, taking the time to draw on a group of leaders to represent a specific region or practice and bringing them together to drive the change that you call governance is critical. 

Another good example of that is watching what is happening now with the go-live for the VA. Very, very bold. They are trying to have the whole VA system and the Department of Defense be on a single instance of Oracle. That’s a bold undertaking from a governance perspective, in terms of having everybody work together and use that same platform in a similar fashion.

Implementation of AI is more of a blank slate than bringing up an EHR since health systems can set up just about any logic and workflow they want, good or bad. How will AI governance work?

I wouldn’t necessarily say that we have a blank slate today. We’ve now been through over a decade, almost 15 years following HITECH, of doing EHRs. Some organizations have been on that same EHR, while others have gone through a second go-live with another EHR. Some have gone through mergers and acquisitions.  

What I see, and what I keep hearing from the different organizations that I speak with, is that physicians and other healthcare providers and users are tired of that “unlearn something old, learn something new” unlearn-relearn technology cycle that we’ve entangled our healthcare providers in. Our human nature is more inclined towards inertia and the status quo than it is to these iterative cycles of rapid change. For example, I may offer a physician a better, more efficient way to do something, but it’s not that unusual for them to decline, saying they would rather keep their current process and workflow even if it is broken. 

I see what’s coming forward with AI as incredible. It’s going to be another technical revolution. But I’m concerned that we now have a large amount of change fatigue, and in some cases burnout, from all of the change that we have been throwing at providers for the last decade and a half. They predict that the way we practice medicine will completely change in the next five years, and that is both exciting and frightening. But solid AI governance processes are the key to helping organizations throttle how they unfold that technology so that we have a legacy of innovation and equity, not burnout and the dissolution of the doctor-patient relationship.

More physicians on the medical staff are employed directly by health systems now instead of being based in the community or contracted through an external company. How has that affected the integration of physicians into technology decisions or their ongoing technology training?

I always found that group of community-based doctors to be an outlier in how we handled them during our lives. Their office often used a different EHR than the one in the hospital where they worked. It wasn’t a given that you would automatically just bring them up in their practice on the same EHR. They would use some sort of interface in their office to be able to use their office-based EHR that was interfaced to the hospital EHR. That was a clunky way of thinking about things, and something that I really had wish we had been more forward thinking about in terms of continuity of care across the continuum of care in medicine.

I would not say that it’s a big difference in terms of how we engage with them. Often they were powerful because they brought  lot of money into the organization, so there was a high level of sensitivity to making sure that their EHR worked well for them. But engaging them in governance and in consensus was the same as it was for any other group.  Again, with that added caveat that when we were looking at workflows, it was the hospital-based workflows and not necessarily how it would always work for their EHRs within their office.  But we often would go out and do a visit into their offices just to make sure that there was something that was working well and that it wasn’t double entry, or that something was inclined to making more errors than not.

How do you see the role of the CMIO changing?

I am hopeful that CMIOs over the last decade and a half have shown that they are strong leaders. I would love to see them elevated from what is oftentimes a “small C” in the organization to a “large C,” where they have a seat at the table with the CEO, CMO, and CIO. They do in some organizations, and some they don’t. But there has been recognition of the expertise that they bring to the table, as well as an evolution in what the CMIO is expected to be able to do, that has caused that role to be elevated to a higher level. 

As we move towards more AI -driven technological revolution in healthcare, that voice, that person, and that expertise is going to be critical. Over time, roles have been renamed. They have become the chief digital officer or chief AI officer. It may go that way instead of just changing the world of the CMIO to embrace a broader swath of what is technology. They may create these other roles that are more specialized. Either way, the CMIO has been elevated in stature and importance within every organization that is seeing just how much technology touches every aspect of healthcare.

Morning Headlines 4/10/24

April 9, 2024 Headlines No Comments

Avant Technologies Acquires Wired-4-Health, Advancing AI Interoperability in Healthcare Data

AI software development company Avant Technologies acquires Wired-4-Health, which offers healthcare technology and data integration services.

Model N to be Acquired by Vista Equity Partners for $1.25 Billion

Vista Equity Partners will acquire life sciences revenue optimization vendor Model N in a $1.25 billion take-private deal.

Rivia Health Raises $3.25 Million in Series Seed Funding with PHX Ventures

RCM vendor Rivia Health raises $3.25 million in a seed funding round led by PHX Ventures.

News 4/10/24

April 9, 2024 News 1 Comment

Top News

image

A second ransomware group – likely a disgruntled affiliate of the Blackcat/ALPHV group – threatens UnitedHealth Group with the sale of data that was stolen during the February ransomware attack on Change Healthcare if the company doesn’t pay up.

RansomHub claims to have access to 4 terabytes of data, though it hasn’t provided proof.

Cybersecurity analysts believe that RansomHub worked with Blackcat during the initial attack, but was cut out of the $22 million ransom that was reportedly paid by UnitedHealth.

UnitedHealth Group’s dashboard shows that one product has been fully restored (Reimbursement Manager), 12 have been restored with partial service, and six are being restored. The target date to have all services restored is the week of April 22.


HIStalk Announcements and Requests

image

I ran across stealth startup Photon Health, which seems to address my gripe that e-prescribing forces patients to choose a pharmacy at the time of prescribing, which means price shopping is nearly impossible and changing the pharmacy requires the prescriber’s involvement. The prescriber sends the prescription to the patient’s electronic wallet, from which they can then send it to any pharmacy after checking product availability and store hours and location. The app then gives the patient the expected availability time, or if they indicate they want to pick it up in the future, allows the pharmacy to queue filling. I tried the website option to send a sample prescription to my phone, which then allowed selecting a pharmacy, although I didn’t see an option to display pricing or use insurance information. I would also want to know how the app ensures that only one prescription copy is active if the patient controls its destination.


Webinars

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


Acquisitions, Funding, Business, and Stock

Vista Equity Partners will acquire life sciences revenue optimization vendor Model N in a $1.25 billion take-private deal.


Sales

  • Boston Medical Center will use technology and services from Medically Home as a part of its new Hospital at Home program.
  • Houston Methodist will implement Prolucent’s workforce platform and vendor management system.
  • Community Health Network (IN) will implement Notable for chart review, care gap scheduling, and pre-visit planning.

People

image

Sean Henson (Wellvana Health) joins NantHealth as SVP and GM of NaviNet.


Announcements and Implementations

image

Overlake Medical Center & Clinics (WA) implements Nuance’s DAX Copilot automated clinical documentation software.

Verato adds AI features to its identity management platform, which makes recommendations for task resolution, clarifies patient matching decisions, and explains its recommendations in conversational language. The Smart Steward assistant is powered by Google Cloud’s Vertex AI.


Privacy and Security

The American Hospital Association posts its second warning that hackers are calling hospital IT help desks to ask for password resets — providing personal employee information to answer security question and enrolling new cell phones to receive multi-factor authentication codes — then using the employee’s compromised email account to reroute vendor payments to their own accounts or to deliver malware. AHA recommends that the help desk call the employee’s call-back number before changing their credentials, verifying the change with the employee’s supervisor, and either verifying the requester’s identity via a video call or asking them to send a screen shot of their government-issued ID. AHA notes that one large health system is requiring employees to visit the IT help desk in person for password resets, although it didn’t say how they address remote employees.


Other

image

Patients who use the Pip Care surgical care app spend less time in the hospital and are far less likely to be readmitted within a week of surgery, according to a comparative study of UPMC patients who underwent certain elective procedures. Backed by UPMC Enterprises, the Pip Care app offers pre- and post-surgical instructions combined with telehealth coaching.

image

Black Book Research’s latest survey results rank Andor Health first in user satisfaction for AI-powered virtual care solutions.

Press Ganey will add nurse-sensitive indicators and outcomes from Epic to its National Database of Nursing Quality Indicators.

image

Kettering Health (OH) opens its Center for Clinical Innovation at its former headquarters, also the former home of inventor and engineer Charles Kettering. The center will focus on digital health, AI, clinical informatics, and other tech projects. Fun fact: Kettering, a General Motors executive, invented the electric starter for cars and Freon, the now nearly phased-out ingredient in modern air conditioning units.


Sponsor Updates

  • AGS Health publishes a new whitepaper, “The RCM Maturity Framework: A 4-Stage Journey to Digital Transformation and Operational Excellence.”
  • Availity adds Predictive Editing capabilities to its Essentials Pro RCM platform, giving providers the ability to identify potential claims denials prior to submission.
  • Symplr expands its partnership with Visier, embedding its HR analytics into Symplr Performance software for improved data and decision-making to engage and retain employees.
  • CloudWave and FDA renew their agreement to share threat intelligence related to medical devices.
  • Wolters Kluwer Health makes its Ovid Synthesis evidence-based practice workflow application available for participants and mentors involved in two of the Association for Nursing Professional Development’s academy programs.
  • AvaSure upgrades its Analytics portal, part of its AI-powered Intelligent Virtual Care platform, with Microsoft PowerBI tools to help providers conduct deeper analysis of critical metrics.
  • Louisville Business First honors Bamboo Health Chief People Officer Annie Likins with its 2024 Enterprising Women Award.
  • CereCore partners with Tennessee College of Applied Technology to equip its graduates with CereCore’s Clinical Support and IT Help Desk jobs.
  • Net Health launches a digital musculoskeletal thought leadership program, Harnessing the Potential of Digital MSK Care, with the American Physical Therapy Association.
  • Clinical Architecture releases a new episode of The Informonster Podcast, “Data Quality in Healthcare.”
  • Dimensional Insight will exhibit at the annual AMGA conference April 9-12 in Orlando.
  • DrFirst will exhibit at the NAACOS Spring Conference April 10-12 in Baltimore.

Blog Posts


Contacts

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

Morning Headlines 4/9/24

April 8, 2024 Headlines No Comments

Second Ransomware Group Demands UnitedHealth Pay for Stolen Data

RansomHub threatens to sell data stolen during the February ransomware attack on Change Healthcare if the company doesn’t pay a second ransom.

FocalPoint Holdings and CodexIT Join Forces to Acquire Conclusn, Building a Best-in-Class Healthcare Analytics Dashboard System

Healthcare software developer FocalPoint Holdings forms a joint venture with health IT and consulting firm CodexIT to acquire healthcare analytics company Conclusn.

Grow Therapy Raises $88M Sequoia Capital-Led Series C to Advance Effective Mental Healthcare

Mental health technology company Grow Therapy raises $88 million in a Series C funding round, bringing its total raised to $180 million.

Rater8 Accelerates Expansion With Strategic Investment

Provider reputation management and patient feedback company Rater8 raises an undisclosed amount of Series A funding.

Curbside Consult with Dr. Jayne 4/8/24

April 8, 2024 Dr. Jayne No Comments

I found myself working this weekend in the path of totality for the solar eclipse. I’m glad I booked my travel almost a year in advance because standard rental cars aren’t available from the usual national brands. Rates for the remaining luxury vehicles are upwards of $400 per day, so I was glad to have locked in at $47 when I did.

My conference-rate hotel was also locked in at $104 per night and my hotel is sold out. I’m fairly certain they are not used to having so many guests, because they don’t have enough towels to restock the guest rooms in real time. They’re picking up towels in the morning, laundering them, and replacing them around dinner time. Management has been extremely apologetic, and I feel for them having to staff around a conference that always happens during this particular timeframe and then having an eclipse thrown on top of it.

It’s been interesting to hear people in the hotel restaurant talk about it. This morning, I sat next to someone who traveled 1,700 miles to experience a total solar eclipse. Based on the weather forecasts, there’s a good chance it will be cloudy on Monday, but even if you can’t see the sun, the eclipse will still happen. I was in the path of totality in 2017 as well, and it was pretty wild to feel the temperature drop and hear the bird song disappear, only to be replaced by the sound of crickets.

The pinhole viewer that I built worked well despite the fact that I made it from a cereal box and aluminum foil. Since I’m traveling this year I plan to just stick with a pair of certified eclipse viewing glasses. A recall has been issued for certain glasses that were sold at convenience stores in the area, which is sad as well as potentially devastating that someone would create counterfeit glasses that could lead to serious eye damage.

In anticipation of everyone wanting to go outside for the minutes of full totality, I made sure we have a gap in the agenda to accommodate it. I did something similar in 2018 when the first SpaceX Falcon Heavy rocket was launched, taking advantage of a high-end conference room projection system to see it live. For the people who were paying my salary back then, don’t worry, I worked it into the change management seminar I was presenting. I guarantee that people walked away with lessons in teamwork and diversity as well as having experienced history being made.

With respect to this year’s eclipse, several governors have made emergency or disaster declarations in advance of the arrival of throngs of people to their states. When people question why they might do that, I explain that it’s all about scarce resources and disruption of processes. I’m in an area that’s not exactly a tourist mecca and I guarantee that people will be pulling over on the interstate tomorrow, creating increased risk for first responders and ambulance traffic around the regional medical center. I’m sure there will be fender-benders as well if people are driving distracted.

It’s going to be in the 80s here tomorrow, which is unseasonably warm for this area, and that will increase the risk of heat-related illness. I met a traveler whose medications were in a piece of checked luggage that went missing, so they are going to need to get a replacement prescription and possibly need to visit an urgent care if their physician doesn’t manage the request on a weekend. I also chatted with some adults who were chaperoning a school trip to see the eclipse. They mentioned that so many teachers requested time off to experience it with their families that they didn’t have enough substitutes to fill the gaps, so the school decided to cancel for the day. They were planning on spending Sunday visiting some sites that were important to the Civil Rights Movement in the 1950s, so learning will going on that goes beyond just science.

A lively discussion is underway in one of the American Medical Informatics Association forums about the use of Microsoft Teams as a clinical communication platform. Many people have chimed in about their experiences with various types of messaging, including EHR-based secure chat, third party solutions, and use of old-school telephones and pagers. An article from the Journal of Medical Internet Research that was mentioned looked at use of an integrated EHR-based secure chat in a large Midwestern health system. Data was collected from July 2022 to January 2023 and analyzed with regard to message volumes, response times, message characteristics, user roles, work settings, and messages sent and received by users.

Researchers identified 9.6 million messages that were sent by 33,000 users. Nurses sent 40% of them, followed by physicians at 25% and medical assistants at 12%. Many users interacted with 20 more more messages per day, leading the authors to raise concerns that short message response times (average 2.4 minutes) and high volumes “highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors.”

We hear a lot about workflow and the burdens that are associated with increasing message volumes, but I don’t see a lot of people talking about the impact on thought process and errors. Research has shown that true multitasking is a myth, and we’ve all seen the negative impacts of trying to do too many things at one time without enough focus.

The always-on nature of communication these days tends to make many clinicians I know feel edgy, like they can never turn off their workday. In my online forums, I routinely see questions from clinicians on how to disable messaging during non-work hours. One physician resorted to getting a separate work phone and having her spouse lock it in a drawer during her off times because she couldn’t help but check it all the time, fearful of missing something. Hopefully, that’s an outlier scenario, but it illustrates how caregivers are being impacted by technology.

The study also found that across 14 hospitals and 250 outpatient clinics, weekly message volume grew by 31% in a six-month period. It had some limitations, one of which was that they were unable to link the data with work schedules or to identify when messaging was being conducted during non-working hours.

The authors noted that additional work is needed to better understand whether secure messaging is replacing other methods of communicating, such as phone calls, or whether it is “simply increasing the overall burden of communication.” They also cited concerns on whether secure messaging is less efficient than other real-time modalities and whether the asynchronous nature of messaging increases the time to resolution of patient issues, since messaging conversations had a median duration of 25 minutes compared to what would likely have been a much shorter phone call.

Notwithstanding the need for additional research, it’s important to make sure that healthcare delivery organizations have their systems configured correctly so that the right people are receiving messages at the right time. Clinicians shouldn’t be expected to respond to secure messages 24×7 unless they are on call. Being able to have true downtime is essential to healthy functioning, whether people realize it or not. Clinicians should also be well-educated in how to set their accounts as “away” or similar so that other users don’t simply fire messages into the ether and hope for the best. From the virtual water cooler, it sounds like there are some opportunities in setup and education.

How does your health system handle secure messaging? Is it a helpful tool or an electronic tether that clinicians feel they can’t escape? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Navigating the Talent Terrain: Choosing Between Full-Time Employees and Fractional Resources in IT Hiring

April 8, 2024 Readers Write No Comments

Navigating the Talent Terrain: Choosing Between Full-Time Employees and Fractional Resources in IT Hiring
By Eric Utzinger

Eric Utzinger is co-founder of Revuud of Charlotte, NC.

image

Every day, healthcare leaders are faced with critical decisions regarding their IT staffing strategies. Among the most significant decisions is whether to hire full-time employees or use fractional resources. Both options offer unique advantages and challenges, and IT hiring managers must carefully consider various factors before making a choice that aligns with their organization’s goals and needs.

Full-time employees are individuals who work for an organization on a permanent basis, typically receiving benefits such as healthcare, retirement plans, and paid time off. They are fully dedicated to the company and work a set number of hours per week.

Fractional resources — also known as contract workers, consultants, or freelancers — provide services to an organization on a part-time or temporary basis. They are hired for specific projects or tasks and may work remotely or onsite as needed. Fractional resources offer flexibility and scalability, allowing businesses to access specialized expertise without the long-term commitment of hiring full-time staff.

These are the factors to consider.


Expertise and Specialization

Full-time employees often offer deep institutional knowledge and continuity, which can be invaluable for long-term projects and organizational stability. They can be trained and groomed to align with the company’s culture and values. However, fractional resources bring diverse skill sets and specialized expertise that may not be available internally. They can provide fresh perspectives and innovative solutions to complex challenges.

Cost Considerations

While full-time employees may entail higher initial costs due to salaries, benefits, and overhead expenses, fractional resources offer cost savings in terms of flexibility and scalability. Organizations can hire fractional resources on a project-by-project basis, avoiding long-term financial commitments and reducing overhead costs associated with maintaining a full-time workforce.

Flexibility and Scalability

Fractional resources provide organizations with the flexibility to scale their workforce up or down based on project demands and business needs. This agility is particularly beneficial in industries with fluctuating workloads or seasonal demands. Full-time employees, while offering stability, may lack the flexibility to adapt to changing circumstances without incurring additional costs or disruptions.

Time-to-Hire and Onboarding

Hiring full-time employees typically involves a longer recruitment process, including sourcing, interviewing, and onboarding, which can delay project timelines and impact productivity. In contrast, fractional resources can be onboarded quickly, allowing organizations to address immediate needs and accelerate project delivery.

Risk Management and Compliance

Full-time employees are subject to labor laws, regulations, and employment contracts, requiring organizations to adhere to various compliance requirements. Fractional resources, while offering flexibility, may introduce legal and regulatory risks if not properly managed. IT hiring managers must ensure that contractual agreements are clearly defined, and compliance standards are met when engaging fractional resources.


When determining whether to use full-time employees or fractional resources, IT hiring managers should carefully evaluate the unique needs and priorities of their organization. It’s essential to assess factors such as expertise, cost considerations, flexibility, scalability, risk management, and organizational culture.

In some cases, a hybrid approach combining full-time employees with fractional resources may offer the best of both worlds, providing the flexibility to leverage external expertise while maintaining core internal capabilities. By leveraging the strengths of each staffing model, organizations can optimize resource allocation, enhance agility, and drive innovation in an increasingly competitive market.

Ultimately, the decision between full-time employees and fractional resources requires a nuanced understanding of the trade-offs involved and a strategic assessment of the organization’s priorities. By weighing the considerations outlined above and aligning staffing decisions with overarching business goals, organizations can position themselves for success in the ever-evolving landscape of IT.

Morning Headlines 4/8/24

April 7, 2024 Headlines No Comments

Teladoc Health Board of Directors Announces Leadership Transition

Teladoc shares rise slightly on the news that the company’s board fired CEO Jason Gorevic after 15 years in that role.

Amwell Receives Continued Listing Standard Notice From NYSE

Telehealth company Amwell risks having its shares delisted by NYSE due to low share price.

Change Healthcare wants data-breach lawsuits heard in Nashville federal court

Change Healthcare asks the court to consolidate lawsuits related to its February data breach in the federal court in Nashville, its hometown.

Monday Morning Update 4/8/24

April 7, 2024 News 6 Comments

Top News

image

The board of Teladoc Health fires CEO Jason Gorevic after 15 years in that role. CFO Mala Murthy will take over as interim until a permanent successor is recruited.

TDOC shares rose slightly on the news, valuing the company at $2.4 billion, but have lost nearly 50% of their value in the past 12 months. They are down 95% from their all-time high in February 2021, shortly after the company acquired Livongo for $18.5 billion and before Teladoc took a $13.7 billion write-down of that business in February 2023.

image

In related news, telehealth competitor Amwell risks having its shares delisted by NYSE due to low share price. They are at $0.72 after losing another 10% following the announcement, valuing the company at $208 million. AMWL shares have lost 67% in the past 12 months and are 98% off their all-time high from early 2021.


Reader Comments

image

From Bluebella: “Re: grammar. You need this shirt.” Actually not, since I am judgment-free on spoken grammar, and in fact I relish hearing (and using) regional accents, word usage, and unusual expressions. Those are real-time artifacts of our upbringing, over which we had no control. I am only annoyed by sloppiness in the written word, where people expect strangers to read their thoughts, but are too lazy or indifferent to edit or to even bother reading what Siri spat out. The first-impression distinction between looking unintelligent versus merely lazy and disrespectful to the reader doesn’t much matter. Hopefully the bar will be raised by AI tools, where even poorly expressed and error-ridden writing can be easily turned into polished prose as smoothly as Google Translate converts Spanish to English.

image

From Ormond: “Re: physicians. A doctor posted this email sent to PCPs by the local hospital.” I assume that the EORH identifies the source as 140-bed East Ohio Regional Hospital, which ironically is owned by a psychiatrist who bought the hospital after it was closed by a for-profit company that has since gone out of business. This memo, assuming it is authentic, could be interpreted as an order – unwisely documented in writing — to commit billing fraud by overriding medical needs and patient preference to book business for EORH’s specialists and to crank out follow-up visits. Patients must be no-showing those medically questionable follow-ups frequently if PCPs are expected to schedule 32 patients per day while seeing only 20-24.


HIStalk Announcements and Requests

image

Cash beats the touchy-feel stuff for employers who want to retain poll respondents as employees, although the ability to work remotely remains a hot button.

New poll to your right or here: What healthcare-related organization frustrated you the most in the past 12 months?

image

Forget ChatGPT – the most impressive AI product is Suno, which can generate amazing songs given the user’s specifications. I requested a dark, operatic metal song about a menacing stranger ringing the doorbell, which generated a really cool, Nightwish kind of Flying V head-banger that you can stream here. Musicians now get to join writers and artists in questioning their future given AI’s ability to create similar works at any user’s command, and given the huge financial stakes, musicians will be lawyering up to figure out whether Suno’s training used their work or creates music that sounds like theirs.


Thanks to these companies that recently supported HIStalk.

image
image


I asked what the #1 realistic first step should be for improving US healthcare outcomes, cost, and accessibility. Lots of folks missed the “realistic” part and went right for the healthcare Hail Mary, but I like that they were thinking big. Anyway, here’s what people said, with responses combined and the total count listed where appropriate:

  • Single payer / universal coverage / Medicare for all / public option (33)
  • Eliminate employer-sponsored health insurance (8)
  • Full transparency / simplification of prices charged by doctors, hospitals, and clinics (4)
  • Standardize claim format / implement uniform pricing / pay the same price for procedures and prescriptions (3)
  • Set a higher tax on processed foods or improve food quality / offer incentives for maintaining a healthy weight (3)
  • Increase payments to primary care providers  / add family medicine providers (3)
  • Create national HIE that is run by CMS / increase interoperability (2)
  • Get rid of insurance as the backbone of healthcare / require paying cash (2)
  • Set Medicare pricing for all patients, adjusted regionally
  • Expand VA eligibility
  • Take the government out of the healthcare business
  • Reform the tort system
  • Add medical schools to increase the supply of physicians to lower salaries, which is the biggest cost
  • Increase spending on primary care for children
  • Remove payers from physician decision-making and workload
  • Develop a plan and incentives to move from a sickness model to a wellness model
  • Add more clinical hospitals in outer suburbs or rural areas
  • More emphasis, access, and education on preventative care / pay physicians based on preventative care services instead of increasing payer profits as providers struggle (2)
  • Increase accessibility to digital health products without a prescription
  • Reduce documentation requirements
  • Eliminate smoking
  • Eliminate conglomerates and mergers / don’t allow for-profit entities and private equity to buy health systems
  • Require private equity and publicly traded firms to divest all hospital / clinic assets
  • Pilot virtual-first health plans
  • Clean up and consolidate data for analytics and decision-making
  • Remove CMS from HHS control and turn it into a public benefits corporation
  • Mandate use of a consumer usage transparency tool with binding real-time estimates, insurance coverage details, and quality metrics for procedures
  • Keep providers independent
  • Make the entire healthcare industrial complex non-profit
  • Create a national license for telehealth providers
  • Implement and enforce mandatory staffing ratios
  • Pay physicians based on panel size and management instead of RVUs
  • Eliminate lobbyists and campaign contributions
  • Eliminate direct-to-consumer drug advertising
  • Better detection and prevention of fraud

Webinars

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


Acquisitions, Funding, Business, and Stock

The Global X Telemedicine and Digital Health exchange-traded fund lost 2.4% of its value in the past 30 days, 22% in the past year, and 42% since it was launched in mid-2020. A $10,000 investment at launch would be worth $5,680 now versus the $15,360 you would have earned by just buying the S&P 500 index.


People

image

Christine Swisher, PhD (Project Ronin) joins Oracle as VP of health data intelligence.


Announcements and Implementations

image

UnitedHealth Group hasn’t updated its Change Healthcare cyberattack update page since March 27. The Optum solution dashboard shows 23 of 137 applications restored. UHG got screwed if it actually paid the $22 million in speculated ransom that showed up on the hacker’s Bitcoin blockchain over a month ago. Meanwhile, the company sides with the plaintiffs in asking the court to centralize the cases in the US court in Nashville, which is Change’s home city, for efficiency.

A Kaiser Permanente study finds that AI triage of patient-sent messages allowed one-third of them to be diverted to other employees, saving time for the physician who otherwise would have had to read and route them.

A NEJM-published study finds that semaglutide — and presumably the other GLP-1 drugs that are best known for weight loss and Type 2 diabetes control – is effective for treating certain types of heart failure. A study published last week tentatively showed that the drugs may slow the advance of Parkinson’s disease symptoms, while previous research suggested their value in reducing inflammation. Interesting work remains to be done to determine whether the unexpected benefits are due to the intrinsic properties of the drugs or the improved general health of patients after they lose weight. I predict that barring any discovery of catastrophic side effects, GLP-1 drugs will be the most significant of all time in terms of life extension, or at least right up there with vaccines, penicillin, and insulin.


Government and Politics

image

The owner of two telemedicine companies pleads guilty to his involvement in defrauding Medicare of $110 million. Telemarketing companies generated lists of Medicare beneficiaries, then paid the telemedicine companies to find providers who would generate prescriptions for durable medical equipment without contacting the patient (seems like those providers should be charged as well, but DoJ didn’t say). The telemarketing companies then sold the orders to DME suppliers so they could submit false claims. The LinkedIn of Steven Richardson, aged 40, includes years running a South Florida “healthcare marketing group” whose work looks like a Medicare fraud keyword list in “assisting patients with their diabetic testing supplies, pain, and compound management.” I Google-stalked his Florida house, which looks pretty nice for spending time wearing an ankle monitor.

CMS drops the requirement that providers submit appropriate use criteria (AUC) as a condition of being paid for performing advanced diagnostic imaging. The long-delayed AUC program was implemented as part of the Protecting Access to Medicare Act in 2014.


Other

image

A major New York Times article looks at data analytics firm MultiPlan, which tells payers how much less than the billed price they should pay providers for out-of-network cases. MultiPlan pockets up to 35% of the savings, sometimes earning more than the billing provider, with the patient potentially on the hook to pay the difference. MultiPlan’s president and CEO as of March 1 is former Cerner executive and Oracle Health GM Travis Dalton. MPLN shares are at $0.84, down 27% in the past 12 months, valuing the company at $550 million as it faces NYSE delisting. Dalton’s shares at signing were worth $13 million plus $2 million per year in salary and bonuses. MultiPlan went public via a SPAC merger in October 2020 at an implied valuation of $11 billion, with share price having dropped 91% since. Financials aside, I might have to side with the company on this one and instead blame self-insured employers and payers who create a network that has no available providers, sending desperate people to specialists who may well have sold their practices to private equity firms who love out-of-network billing.


Sponsor Updates

  • Lotus Weight Loss & Wellness (KY) reports a 30% increase in new patient visits after implement EClinicalWorks EHR and Healow Open Access software.
  • Experity will exhibit at the Urgent Care Association Conference April 13-17 in Las Vegas.
  • Findhelp will present at the National WIC Association Annual Education and Training Conference April 7-10 in Chicago.
  • FinThrive releases a new Healthcare Rethink Podcast, “Population Health is Becoming Precision Community Health.”
  • Health Data Movers publishes a new “Cancer Data Abstraction.”
  • Inovalon releases a new INovators Podcast, “AI in Healthcare: The Value of Innovative Technology, Paired with Clinical Expertise.”
  • Mobile Heartbeat will exhibit at AONL 2024 April 8-10 in New Orleans.

Blog Posts


Contacts

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

Morning Headlines 4/5/24

April 4, 2024 Headlines 1 Comment

Massachusetts Justices Mull Applying Wiretap Law to Web Tracking

A court reviews a class action lawsuit that argues that hospital use of web tracking technologies violates the state’s Wiretap Act.

Cerberus says its investment in Steward hospitals yielded an $800 million profit

The investment firm tells a Senate subcommittee that its only cost in creating the now-struggling, for-profit Steward Health Care that it sold at an $800 million profit was buying Caritas Christi for $246 million.

Former University of Iowa Hospital employee used fake identity for 35 years

A hospital network architect pleads guilty for living under another man’s identity since 1988, which caused that man to be wrongly confined to jail and then a mental hospital for 20 months.

News 4/5/24

April 4, 2024 News No Comments

Top News

image

The Massachusetts Supreme Judicial Court is reviewing a class action lawsuit that claims that New England Baptist Hospital and Beth Israel Deaconess Medical Center violated the state’s Wiretap Act by using undisclosed web visitor tracking technologies such as Meta Pixel to secretly intercept website user communications.

Key issues:

  • Are web visitors who just look at web pages conducting a “conversation” that is protected by the Wiretap Act?
  • Is the information collected secretly when visitors are notified that the website uses website traffic analysis tools?
  • Are website warnings sufficient when they do not explicitly tell visitors that their medically-related search or form entry information is shared with third parties?
  • Were hospitals misleading people by promising to protect their privacy when the technology was specifically designed to help identify them?

Reader Comments

From AI Ball: “Re: AI in healthcare. Are patients demanding more of its use, or are we again speaking on their behalf without actually asking them?” The latter. Surveys suggest that people are wary of sticking AI into a process that is already cumbersome and impersonal. Consumers will flock to Dr. AI as they did Dr. Google for looking up symptoms or conditions, generating plain English interpretations of medical gobbledygook, or perhaps even searching for providers. Otherwise, they have zero interest in AI-powered clinical documentation and literature searches unless it frees up doctor time so they can actually get an appointment or experience a less-rushed visit. I believe it’s also true that technologists who think doctors are desperate for AI-supported diagnosis, image analysis, or precision medicine help should probably actually ask those doctors. In the case of health systems, think of the most impersonal, maddeningly inefficient bureaucracies that you dread dealing with over billing or service issues – the DMV, a utility, an online merchant, or your local sprawling health system – and ask yourself if your experience is likely to improve if they add AI without changing anything else. Or, as a form of real-world evidence with earlier technologies, did you love it when those same bureaucracies hid their humans behind automated attendants or simply let the phones ring unanswered? TL;DR – companies do whatever benefits them most and customers win only if companies fear losing their business.


Webinars

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


Acquisitions, Funding, Business, and Stock

Venture studio Aegis Ventures will collaborate with nine health systems to co-develop and invest in health tech solutions, with a common theme of using AI and automation. The studio’s collaboration with Northwell Health resulted in the creation of four companies, including Optain (AI-powered retinal imaging) and Upliv (menopause virtual support).

Epic is developing an AI validation suite to help health systems evaluate and monitor the performance of AI models, both third party and self developed.

Manifold, which offers an AI-powered clinical research platform, raises $15 million in a Series A funding round.

AI-enabled workforce marketplace SnapCare acquires Medecipher, which offers a predictive analytics staffing decision support tool.

Investment firm Cerberus Capital Management tells a Senate subcommittee that it paid $246 million for Caritas Christi Health Care in 2010, didn’t invest a penny more as it turned it into for-profit Steward Health Care, and then sold it for an $800 million profit in 2020. A consulting firm says that level of return isn’t exactly a home run in private equity world of quick flips, although the partners usually get management fees on top of profits from the sale. Cerberus declined to tell the senators how much the firm and its executives made from its investment.


Sales

  • Springfield Clinic (IL) expands its use of Health Note’s patient engagement and intake platform.
  • Jordan Valley Community Health Center (MO) will implement Epic.

People

image

UK HealthCare hires Katie Dickens, MSA (Bronson Healthcare) as chief digital and information officer.

image

Imaging real-world data vendor OneMedNet promotes Aaron Green to president and CEO following the retirement of CEO Paul Casey.

image

Symplr promotes Allison Morin, RN, MSN to chief nursing informatics officer.

image

Andy Dé, MS, MBA (MedeAnalytics) joins Verato as chief marketing officer.

image

DrFirst promotes Irene Froehlich to chief brand officer.

image

Gary Hall, who retired as CIO of Estes Park Health (CO) in September 2023, is elected mayor of Estes Park.


Announcements and Implementations

image

A report by the American Organization for Nursing Leadership and Laudio looks at the impact of hospital nurse managers:

  • The median span of control is 46 employees, with 25% of inpatient nurse managers having responsibility for 78 or more employees. Spans are largest in ED and ICU.
  • A larger span of manager control is associated with higher rates of RN turnover, use of overtime, and burnout.
  • While 56% of nurse managers have at least one assistant nurse manager, nurses almost always report directly to the nurse manager.
  • RN retention is higher when managers have purposeful interaction with them at least monthly, most influenced by recognition and celebration.

HCA Healthcare integrates referrals to Talkiatry’s virtual psychiatry service with its EHR.

image

A new KLAS report on managed help desk and application management services names Pivot Point Consulting as #1 in performance, followed by CereCore. Nordic and Tegria were noted as being able to scale but with customer-reported problems with staff consistency. Most respondents plan to maintain or increase their use of managed IT services to mitigate cost and staffing challenges.


Government and Politics

Matthew Keirans, who worked 10 years for University of Iowa Hospitals & Clinics as a network architect, pleads guilty to stealing the identity of an acquaintance named William Woods and using it for 30 years to take out loans and to obtain his remote hospital IT job. Woods visited his bank in 2019 to alert them that someone was running up debt using his account, but they became suspicious even though he showed ID. The police were called and they contacted Keirans, who faxed them phony documents – including one that included the wrong middle name of Woods — that resulted in the arrest of Woods, who spent the next 20 months in jails and mental hospitals. Once released, Woods notified the hospital that their $140,000-per-year employee was not him, which detectives proved using DNA evidence. Keirans faces up to 32 years in prison and a $1.25 million fine.


Privacy and Security

A University of North Carolina at Chapel Hill’s medical school employee falls victim to a social engineering attack in which they clicked on a malicious link that was sent by a trusted contact, then were tricked into sharing their multi-factor authentication code, which gave the hacker access to their email account.


Other

image

Payers and providers have been slow to adapt biosimilar versions of the antinflammatory injectable drug Humira – which has generated $200 billion in lifetime sales for drug maker AbbVie – because pharmacy benefit management companies and specialty pharmacies would lose most of their profit by dispensing the less-expensive option. The report by the Biosimilars Council and IQVia found that only 1% of Humira patients have been switched to the cheaper alternative, with many of those associated with small payers that don’t have loyalty to the big three PBMs (CVS Caremark, Express Scripts, and OptumRx). The authors conclude that patients, employers, and health plans are paying an extra $700 million per month for sticking with the brand name.

image

An employee of Mayo Clinic Hospital in Phoenix files a proposed class action lawsuit against the health system, claiming that the hospital provided such low-quality health insurance under its self-insured plan that some employees incur $10,000 per year in costs while others avoid seeking care entirely. Also included in the lawsuit is third party administrator Medica, which the plaintiff claims misstated the network status of providers in its member portal. Workers who were contacted by a news site said that Mayo’s remote employees struggle to find affordable care, also noting an insurer’s “phantom network” that lists dozens or hundreds of in-network providers who have retired, no longer accept the insurance, or aren’t taking new patients. The site also found that Mayo’s doctors and executives are reimbursed at up to $10,000 per year to cover the difference between in-network and out-of-network costs, but most employees don’t qualify.


Sponsor Updates

image

  • Five9 celebrates 10 years on the Nasdaq stock exchange by ringing the opening bell.
  • Nordic releases a new Designing for Health Podcast, “Interview with Susan Snedaker.”
  • Optimum Healthcare IT celebrates surpassing 400 go-live projects.
  • SnapCare will exhibit at the Oregon Health Care Association Spring Expo April 11-12 in Salem.
  • Symplr will exhibit at the Health Care Compliance Association’s Annual Compliance Institute April 14-17 in Nashville.
  • Upfront Healthcare will present at the Urgent Care Association’s annual conference April 13 in Las Vegas.
  • PSQH: The Podcast features Wolters Kluwer Health VP and GM of Clinical Surveillance, Compliance & Data Solutions Karen Kobelski, “Preventing Drug Diversion with Technology.”
  • Zen Healthcare IT names Ryan Kopiske technical project manager.

Blog Posts


Contacts

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

Text Ads


RECENT COMMENTS

  1. Honestly, I autocorrected "62 Ventures" as "62 Vultures", and I considered posting snark about same! Is that on me? Is…

  2. $20 million to improve behavioral HIT? That's like 1/7th of a typical Epic install in one hospital. Seems like symbolic…

  3. Regarding the Particle Health - Epic Carequality Drama - it's important to note that most existing national networks separate out…

  4. Re: Tullman/62 Ventures Given his track record for acquiring companies, bungling day-to-day operations and then somehow selling to an unwitting…

  5. Was not the struggle of Teladoc foreseeable with the acquisition of Livongo?

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

 

RSS Webinars

  • An error has occurred, which probably means the feed is down. Try again later.