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Morning Headlines 5/18/22

May 17, 2022 Headlines No Comments

ThoroughCare Announces $3 Million Capital Raise to Advance Care Coordination for Value-Based Care

Care coordination software company ThoroughCare secures a $3 million investment from Cypress Growth Capital.

Chillicothe VA reviewed after allegations of failing to follow a consultation process

A VA Office of Inspector General report determines that lack of prompt EHR documentation and care coordination between a VA provider and private chiropractic clinic contributed to the spinal and rib fractures of an 87 year-old patient.

National Medical Billing Services Announces Acquisition of Medi-Corp, Inc.

National Medical Billing Services, an RCM vendor focused on the surgical market, acquires Medi-Corp, which offers RCM services for anesthesia, ASCs, and pain management providers.

News 5/18/22

May 17, 2022 News No Comments

Top News

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A Venezuelan cardiologist and self-taught programmer is charged with the development, use, and sale of plug-and-play ransomware and creating profit-sharing arrangements with his customers, whom he often persuaded to leave positive online reviews.

The criminal complaint, brought against him by US authorities, claims that “the multi-tasking doctor treated patients, created and named his cyber tool after death, profited from a global ransomware ecosystem in which he sold the tools for conducting ransomware attacks, trained the attackers about how to extort victims, and then boasted about successful attacks.”

The cardiologist’s preferred pseudonyms included “Aesculapius” and “Nosophoros,” Greek words referring to the ancient Greek god of medicine and disease, respectively.


Webinars

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


Acquisitions, Funding, Business, and Stock

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PatientIQ, an outcomes data and insights vendor, raises $20 million in a Series B funding round. The company gathers its data from 1.4 million patients across more than 200 healthcare organizations.


Sales

  • Bon Secours Mercy Health will use Strive Health’s CareMultiplier technology and clinical care teams to improve its care for chronic kidney disease and end stage kidney disease patients across Ohio.

People

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CTG names Scott Clark (Ensono) VP of North American sales.

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Mikael Öhman (TransformativeMed) joins KMS Healthcare as CEO.

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Bakul Patel, former chief digital health officer at the FDA, joins Google as senior director of global digital health strategy.

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University Hospital hires Paul Contino, MA (Guthrie) as CIO.

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Thynk Health hires Jim Farmer (FYNS) as SVP of sales.

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CPSI President and CEO Boyd Douglas will retire from that position and the company’s board on June 30 after 34 years. Replacing him is COO Chris Fowler.


Announcements and Implementations

Novant Health (NC) works with Health Recovery Solutions to launch a remote patient monitoring pilot program for bariatric patients.

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In England, The Queen Elizabeth Hospital King’s Lynn NHS Trust implements enterprise imaging software from Agfa HealthCare.

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In Norway, Helseplattformen brings Trondheim kommune live on Epic. Epic’s Rachel Kantosky reports on LinkedIn,

On top of the complexities of a ‘typical’ Epic install, the team added enterprise applications into a system live solely on Beaker lab, translated over 4 million system terms into Norwegian, and completed several significant development projects, including SFM ePrescribing integration, eMessaging, and digitizing the Norwegian pregnancy card. Go-live is just the beginning and we are looking forward to further rollouts and optimization! I’m also incredibly proud of the 32 American expats who moved their lives to Norway to support this important work.


Government and Politics

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A VA Office of Inspector General report determines that lack of prompt EHR documentation and care coordination between a VA provider and private chiropractic clinic contributed to the spinal and rib fractures of an 87 year-old patient. The nearly century-old Ohio facility is one of 35 that the VA is considering closing within the next several years.

DoD facilities including Naval Branch Health Clinic and the 3rd Combat Aviation Brigade, Hunter Army Airfield, both in Georgia, will transition to MHS Genesis next month.


Other

A lawyer and veteran advocate writes a satirical article on using the VA’s MyHealtheVet to “micro-manage your VA doctor from your sofa.” A snip:

I swear, sometimes, I feel like some VA personnel intentionally dupe us into keeping a request verbal. When the floor falls out on whatever issue you were trying to resolve, when the time comes to “prove it,” the conversation never happened. It will be your word against theirs, and you will lose. Remember, if it’s not written down, it did not happen. This is why tools like My HealtheVet are so great. It can allow you direct access to your care team. It allows you direct access to at least some (but not all) of your health records. It gives you the power to put it in writing even after the appointment, just to be sure everyone is on the same page. What an empowering tool, no? Should your physician refuse a procedure but not write it down, you can send a note about it later that should be added to your records. If you need to appeal the refusal in a clinical appeal, healthcare appeal, or if it comes up in a malpractice matter, the request will be documented.

A nurse and former cardiovascular director sues MercyOne, alleging that she was fired in retaliation after she reported that a cardiothoracic surgeon was not obtaining proper patient consent, was performing too many add-on procedures, lied to patients about likely outcomes, and put patients with poor post-surgical outcomes on ventilators for 30 days so their deaths would not be reported to the Society of Thoracic Surgeons database as being due to surgical complications. She also claims the surgeon screamed at her in a meeting about the issues and referred to her as “this little girl.”


Sponsor Updates

  • About releases a new podcast, “US Healthcare: Understanding Challenging Trends for Hospitals and Health Systems with David Burik.”
  • Availity makes its Enhanced Claims Status, a multi-payer RESTful API, available to its trading partner network.
  • BDO expands its alliance with Microsoft to deliver solutions that create value for its global clients.
  • TechVibe radio features ConnectiveRX VP of Product Development Mary Beth Sirio.
  • Get-to-Market Health celebrates its five-year anniversary.
  • Experity earns 2022 Great Place to Work Certification.
  • Sonifi Health integrates the HealthTouch food service system from MCR Technologies into its interactive patient engagement platform.
  • Imaging data vendor OneMedNet announces a joint referral partnership agreement with data management company Flywheel for biomedical research and collaboration.

Blog Posts


Contacts

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

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Morning Headlines 5/17/22

May 16, 2022 Headlines No Comments

Skylight Health Group Reports First Quarter 2022 Financial Results

Skylight Health Group, a multi-state practice management company, attributes its 18% dip in revenue from the previous quarter to implementation of Athenahealth’s EHR across its practices, and a reduction in COVID-19-related urgent care visits.

Hacker and Ransomware Designer Charged for Use and Sale of Ransomware, and Profit Sharing Arrangements with Cybercriminals

A practicing Venezuelan cardiologist has been charged with the use and sale of ransomware, and profit-sharing arrangements with his customers.

Change Healthcare brings lawsuit against former employee

Change Healthcare sues a former employee, now working at Olive, for violating his contract’s non-compete clause by going to work for a direct competitor.

Curbside Consult with Dr. Jayne 5/16/22

May 16, 2022 Dr. Jayne 2 Comments

With the rise of telehealth, there’s a lot of discussion about “web side manner” and the strategies that physicians and other clinicians should use when evaluating and treating patients via telehealth.

I’ve worked for a variety of telehealth employers, some which require their clinicians to wear a white coat and others who are fine with what they discuss as a “professional” dress code. For many years in the hospital culture, white coats were considered a symbol of being a physician or physician in training. Typically, medical students wore short coats and those with their degrees wore longer coats. However, over time, many other clinicians began to wear white coats both short and long, including pharmacists, nurse practitioners, physician assistants, and more.

The use of the white coat also evolved at the department level. At the hospital where I primarily trained, medical students wore short coats and residents, fellows, and attendings wore long coats. Except, that is, for the surgery department, where interns and first-year residents were further hazed by being required to continue to wear short coats.

However, the policy in the operating suites was that if you were wearing surgical scrubs and needed to leave the area, you were required to put on a long white coat or a “cover gown” to protect the surgical scrubs from non-OR contacts. However, the surgery interns knew they’d get in trouble if they were caught in long coats, so if they left the OR and there were no cover gowns available, they’d have to change back into street clothes and then don new scrubs when they returned. They detested the fact that students could wear the long coats in that situation, but they couldn’t.

The surgery interns were further hazed by being required to wear ties if male, and not being allowed to eat or drink anywhere but the hospital cafeteria or a break room. Where the rest of us could scurry away from the cafeteria holding a to-go cup and finish it in the elevator on the way back to our duty assignment, the surgical residents had to either chug it in the cafeteria or remove the straw to make it look like they weren’t drinking it until they got to their destination. There were a lot of other elements of hazing in those programs, and needless to say, they were a turn-off for a lot of students rotating on the service. This was also long before COVID, when masks changed how we handle food and drink in hospitals.

Since the white coat is no longer a definitive indicator, quite a few of the hospitals that I’ve worked at have taken to other methods to make sure patients know the credentials of different members of their care teams, including oversized name badge frames or backings that contain prominent credentials such as MD or DO or RN written in bold font that is nearly an inch tall. Still, there’s often confusion about who is caring for the patient, as noted in this recent Medscape article.

Despite all our advances in patient engagement and consent, the use of whiteboards, bedside technologies to track the care team, and more, patients are still confused about who they’re talking to. Some of that can have situational influences since hospitals are strange and unfamiliar places with routines that don’t often make sense. Patients may be less perceptive than usual due to illness or being overtired, since we know that hospitals aren’t great places to get rest.

Following the emergence of COVID-19, those bold credential nametags became even more necessary as many of us ditched white coats (which were largely used for their pockets anyway) in favor of scrubs that we could change before going home. Neckties all but disappeared as we tried to understand the nature of this novel pathogen. Other countries had previously moved away from white coats and neckties due to the infection risk, but the US has been a holdout. When I spent some time in a healthcare institution in the UK many years ago, no one wore sleeves of any kind below mid-forearm to allow for better hand hygiene, and neckties had also been voted off the healthcare island.

Still, there’s the question of how clinicians should dress for telehealth visits. The reality is that our world has become much more casual since the start of the pandemic. Plus, there’s no need for those white coat pockets when you’re sitting at a desk and can use a laptop, PC, or phone to access references rather than having to tote around a “Washington Manual” and a “Pocket Pharmacopeia.” However, there’s still that association of the white coat with professionalism.

The article cites research done at Johns Hopkins to look at patient preferences. Nearly 500 adults were surveyed in the spring of 2020. They were asked about various types of dress, including white coats, scrubs, and fleece or softshell jackets with the institution’s logo. They were also asked to rank photos of models in various attire to identify their level of experience, professionalism, and friendliness. Those models in white coats were seen as experienced and professional, while those in softshell jackets were seen as friendlier. Responses varied by age of those surveyed as well as their geographical location. The white coat seemed to be favored by older respondents as a mark of professionalism.

Another study conducted at NYU Grossman School of Medicine in 2018 surveyed over 4,000 patients at 10 academic medical centers. Those patients preferred formal dress and a white coat, but it would be interesting to see what a study of that size would show in the pandemic-era and whether the results would hold across different encounter settings including inpatient, outpatient, and telehealth visits. At least for the majority of patients receiving telehealth services, they’re not being seen by a whole team of people, so I would hypothesize that the white coat is not necessarily helpful to avoid confusion on what type of provider is present.

Personally, I prefer not to wear the white coat while conducting telehealth visits. I wore it only intermittently in my solo practice, mostly because I had no need for the pockets and everyone knew I was the doctor. In the emergency department, I wore it for the pockets, but ditched it when I went to urgent care. I did bring it back for COVID, partly because my employer couldn’t provide adequate gowns and it was one more layer of protection, not to mention I didn’t want a stethoscope around my neck given our initial lack of understanding about COVID transmission – pockets made much more sense.

Still, I wear it on certain telehealth visits when a particular employer requires it, even though I don’t like it and I don’t think the patients really care. It will be interesting to see how telehealth culture evolves over the next few years and whether the white coat becomes more or less of a requirement.

What does your institution think about white coats and telehealth? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/16/22

May 15, 2022 Headlines No Comments

PatientIQ Raises $20M to Transform Patient Outcomes Data into Actionable Intelligence that Advances Clinical Care

PatientIQ, a patient outcomes data and insights vendor, raises $20 million in a Series B funding round.

Amwell Announces Results for First Quarter 2022

Amwell announces Q1 results: revenue up 11%, EPS –$0.26 versus –$0.16, missing analyst expectations for both.

Remote Monitoring and Behavioral Economics in Managing Heart Failure in Patients Discharged From the Hospital: A Randomized Clinical Trial

A randomized clinical trial finds that remote monitoring and financial incentives had no impact on readmissions or deaths among discharged heart failure patients.

Monday Morning Update 5/16/22

May 15, 2022 News 2 Comments

Top News

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Remote monitoring and financial incentives had no impact on readmissions or deaths among discharged heart failure patients, a randomized clinical trial finds.

Participants were given a digital scale, a monitored pill bottle for diuretics, and daily “regret lottery” incentives for providing medication and weight measures from the previous day.

The authors conclude that success may require earlier or deeper patient engagement and might need to include unrelated issues that cause HF readmissions.


HIStalk Announcements and Requests

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These are timely poll results since former Vanderbilt nurse RaDonda Vaught was sentenced Friday to three years of probation (no jail time) following her conviction on negligent homicide charges after killing a patient by giving the wrong medication. Most poll respondents favor open investigations and a review of the work setting rather than charging clinicians with a crime or revoking their license. I spent time reviewing technology-related medical errors in a large academic medical center and the “Swiss cheese effect” is real, where errors were rarely caused by one rogue, incompetent clinician but rather by a series of unusually aligned events, such as systems going down, drug shortages that required substituting an unfamiliar alternative, and lack of coordination in workload-necessitated handoffs among clinicians who weren’t accustomed to working together. It’s not like insurance fraud, where someone takes individual illegal action in return for payment. It’s more like a skilled programmer who makes an honest mistake that affects users because they are overworked or undertrained and the programmer’s employer doesn’t run a competent QA function.

New poll to your right or here: What will be the impact on Epic when CEO Judy Faulkner is no longer involved? She will turn 79 this year and the company’s succession plan will eventually take effect. We saw dramatic changes when Cerner CEO and Chairman Neal Patterson died in 2017, leaving the company without its leader and most visible co-founder for the first time in its 38-year history.

I’m getting more of my “People” updates from LinkedIn since organizations don’t always issue formal announcements. Connect with me and I’ll see and possibly mention your job change. Minimal effort is required and there’s no downside.


Webinars

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


Acquisitions, Funding, Business, and Stock

West Monroe will expand its its digital services business in Western Europe, opening new offices and hiring 1,000 employees.

Amwell announces Q1 results: revenue up 11%, EPS –$0.26 versus –$0.16, missing analyst expectations for both. AMWL shares are down 88% in the past 12 months versus the Nasdaq’s 6.6% gain, valuing the company at $855 million. The company spent most of the earnings call talking about Converge, a technology platform that it says will improve patient connectivity and user experience when interacting with providers and payers.


Sales

  • The UK’s Kent NHS trusts choose Sectra’s enterprise imaging system.

People

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Community Health Systems promotes Paul Novak to CIO.


Announcements and Implementations

TriNetX enhances its real-world research offerings by launching Follow the Patient, which allows researchers to segment, tag, and monitor de-identified patients over months or years.

Hospitals of Community Health Systems that offer OB services implement PeriGen’s PeriWatch Vigilance for maternal-fetal early warning.

HLTH retools its November conference to push attendees into the exhibit hall (or in its own buzzwords, “focus on audience journeys–tailoring pathways through content, programs, and meetings based on a deeper learning about each population and individual that interacts with us.”) Attendees will be required to sit in the exhibit hall for sessions and meals, the conference will emphasize the “hosted buyer” format in which healthcare buyer attendees earn registration discounts for meeting with vendors, and both HLTH and ViVE will offer a digital health innovation track that is co-sponsored with investment company StartUp Health.


Other

South Korea requires hospitals to install video surveillance cameras in operating rooms to record all surgeries involving general anesthesia, as lawmakers address widespread reports of “ghost surgeries” in which doctors turn procedures over to unsupervised assistants. The problem arose in the 2010s as the government started promoted medical tourism and plastic surgeons took advantage of demand by allowing nurses, assistants, and even medical device technicians to perform procedures. The practice then spread to spinal surgery centers that saw a profitable opportunity when faced with high demand and few available doctors to perform relatively uncomplicated surgeries.

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I missed this earlier. Netherlands-based Aimedis creates Aimedis Health City, which it calls “the first hospital chain in the metaverse” in which de-identified data will be exchanged and monetized. It plans to offer provider advertising, virtual consultations, patient and clinician interaction, education, and rehab courses. It will offer space for rent or purchase using its own NFT marketplace.


Sponsor Updates

  • Tegria partners with the One Roof Foundation and Duwamish River Community Coalition to provide asthma remediation items to local families.
  • OptimizeRx will present at the RBC Healthcare Conference May 17-18 in New York City.
  • Olive publishes a new analysis, “Long COVID leads to longer hospital stays, time in OR.”
  • HLTH releases a new podcast featuring Optum MedExpress CEO Kristi Henderson, NP.
  • Community Health Systems will present encouraging results seen after its implementation of PeriGen’s Vigilance early warning and clinical decision support system at the IHI Patient Safety Congress May 16-18 in Dallas.
  • Talkdesk has won 2022 Top Rated Awards for contact center, call center workforce optimization, call recording, and VoIP.
  • Twistle will exhibit at the OR Business Management Conference May 16-18 in San Antonio.
  • Volpara Health will exhibit at the SBI/ACR Breast Imaging Symposium May 16-19 in Savannah.
  • Wolters Kluwer Health publishes a new book, “Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic.”
  • Zen Healthcare IT achieves HITRUST risk-based, two-year certification to mitigate risk in third-party privacy and security.

Blog Posts


Contacts

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

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Morning Headlines 5/13/22

May 12, 2022 Headlines No Comments

Cerner falls short of contract target for ‘uptime,’ prompting McMorris Rodgers to accuse VA of ‘blatant negligence’ over computer outages

Cerner will issue the VA an unspecified credit for failing to meet the minimum system uptime requirements specified in the $10 billion contract.

Managers of Arizona Telemedicine Company Admit Roles in $64 Million Nationwide Kickback, Health Care Fraud Schemes

Two owners of a “purported” telemedicine company plead guilty to participating in an elaborate scheme of bribes, kickbacks, and fraudulent prescriptions for drugs and medical equipment that netted them $32 million and cost insurers $64 million.

OncoHealth Secures Strategic Investments from Arsenal Capital Partners & McKesson Corporation

Oncology-focused digital health company OncoHealth secures unspecified investments from Arsenal Capital Partners and McKesson.

News 5/13/22

May 12, 2022 News 4 Comments

Top News

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Bon Secours Mercy Health launches Accrete Health Partners, a digital holding company that will manage its digital health services, investments, and partnerships.

It will be headed up by Chief Digital Officer Jason Szczuka, JD.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Experity.The Machesney Park, IL-based company is the leading software and services company for on-demand healthcare in the US urgent care market, providing an integrated operating system complete with electronic medical record, practice management, patient engagement, billing, teleradiology, business intelligence, and consulting solutions. Nearly 50% of the US urgent care market runs on Experity solutions. With Experity, providers can best meet the demands of the evolving on-demand space and deliver high-quality, high-velocity care by streamlining operations, improving patient experiences, and optimizing revenue. A GTCR portfolio company, Experity’s leadership is comprised of growth-minded urgent care experts and business leaders committed to improving on-demand healthcare for all. Thanks to Experity for supporting HIStalk.


Webinars

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


Acquisitions, Funding, Business, and Stock

Health Catalyst acquires Armus, which provides clinical registry development and data services.

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This is an insightful comment from digital health advisor Marc Sluijs.


Sales

  • Mount Sinai Medical Center chooses ActX Genomic Decision Support, integrated with Epic.
  • American College of Cardiology chooses the care management platform of Biofourmis as the exclusive virtual platform for its TRANSFORM(3) study.

People

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Kermit Randa (Syntellis Performance Solutions) joins recruiting software vendor Symphony Talent as CEO.

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Ryan McDaniel (Huron Consulting Group) joins Impact Advisors as VP / ERP service line leader.


Announcements and Implementations

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Atrium Health and Advocate Aurora Health announce plans to merge, creating a system that will have 67 hospitals, 150,000 employees, and $27 billion in annual revenue with locations in Illinois, Wisconsin, North Carolina, South Carolina, Georgia, and Alabama. The combined organization will be called Advocate Health, with headquarters in Charlotte, NC and with an academic component in Wake Forest University School of Medicine. Both organizations use Epic. The announcement cited several technology issues as contributing to the decision to merge – healthcare becoming more digital, population health management, and analytics. The health systems pledge to create 20,000 new jobs while making healthcare more affordable.

Microsoft-owned Nuance and The Health Management Academy form The AI Collaborative, which brings together executives of hospitals that are using AI technologies. The big draw for participants is that they get a trip to Microsoft’s headquarters – which always arouses both technical and business geeks – and attend annual summits.

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A new KLAS report on go-live support finds that CSI Healthcare IT is busiest, and along with Experis Health, is best at vetting resources.


Government and Politics

Cerner will issue the VA an unspecified credit for failing to meet the minimum system uptime requirements specified in the $10 billion contract.

Two owners of a “purported” telemedicine company plead guilty to participating in an elaborate scheme of bribes, kickbacks, and fraudulent prescriptions for drugs and medical equipment that netted them $32 million and cost insurers $64 million.


Other

The BMJ reports that drug companies and universities that were found in NHS Digital audits to have breached patient data-sharing agreements – repeatedly, in some cases — have not had their access to that data revoked. The article notes that clinical commissioners authorized the release of patient data to Virgin Care without patient permission and the company then refused to allow NHS Digital to audit their compliance while also refusing to delete the information.

US hospitals are rationing the use of contrast media after a GE Healthcare facility in Shanghai, China temporarily closes due to COVID-19 lockdowns. Experts say not only does most of our contrast supply comes from a single country, hospitals sign preferred vendor contracts that give them no alternative source.

A NordPass review of user passwords finds, not surprisingly, that number-formed combinations starting with “12345” represent seven of the top 10 most common. but a common one I hadn’t thought of us “1Q2W3E,” which alternates top and bottom row keys at the left of the keyboard. A similarly digitally lazy choice at #33 is “ZXCVBNM,” which is the first six bottom-row keys left to right. Several of the commonly used passwords include f-bomb variants, which would make an interesting analysis to see if unrestrained anger toward passwords is linked to even more bitter interaction with online humans.


Sponsor Updates

  • Bamboo Health announces record company growth and the opening of its office in Boston.
  • CereCore joins the ServiceNow Partner Program.
  • Get Well will offer medically-endorsed guided imagery and meditation audio programs from Health Journeys to its customers and their veteran patients.
  • GHX makes Exchange Advantage, a unified platform that automates end-to-end digital transactions, available to all suppliers in North America.
  • Interbit Data publishes a new white paper, “The value of 24/7 access to critical patient data – a nurse’s perspective.”
  • InterSystems will relocate its Boston headquarters, taking up the top 14 floors of a new building at One Congress.
  • Diameter Health publishes a new brief, “Why Upcycling Data Matters.”

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 5/12/22

May 12, 2022 Dr. Jayne No Comments

There is always a lot of buzz around wearables and using them to boost patient engagement. This Bloomberg piece caught my eye with its discussion of the “nocebo” effect. Where a placebo can make patients feel better, a nocebo that’s providing negative data could make patients feel worse. The article points out that not everyone “will truly benefit from 24-7 monitoring, arbitrary goals served up by an algorithm, and regular notifications telling you that you’re stressed, tired, fit, or simply ‘unproductive.’”

I definitely see this with my patients, who are frustrated by what they’re seeing with their bodies because they don’t understand it. For example, the patient starting a new workout plan who is frustrated due to weight gain might not understand that this is because they are building muscle.

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During the course of the COVID-19 pandemic, many clinical informaticists have learned more about public health informatics than they ever imagined. The Strengthening the Technical Advancement & Readiness of Public Health via Health Information Exchange Program (STAR HIE Program) provides support for public health agencies who need to exchange health information during times of emergency. Although the program was initially funded by the CARES act in 2020, it was expanded in 2021 to further support efforts to increase vaccine data sharing between local or regional Immunization Information Systems and HIEs. Various projects have involved: improved delivery of COVID-19 test results; improved reporting among providers, hospitals, and public health agencies; providing accurate lists of non-vaccinated patients to improve vaccination rates; improved case reporting; and creation of new connections between HIEs, hospitals, and correctional facilities.

For those who think “COVID is over,” here’s another example that it’s not and we’re all in this together. Due to COVID-19 lockdowns in China, there is a global shortage of contrast dye that is needed for CT scans. This has resulted in some medical centers rationing CT scans. Organizations are used to having to message patients to reschedule appointments due to physician emergencies or illness, but having to cancel imaging procedures due to lack of supplies is a bit new, so I imagine there’s new reports and new outreach campaigns being created by IT teams. Much like the shortage of intravenous fluids that happened after a Hurricane Maria devastated Puerto Rico, the supply chain is weakened by having too few locations for the manufacture of critical supplies. The shortage is expected to last a few more months and hope this leads manufacturers and distributors to rethink their manufacturing strategies.

Quest Diagnostics releases the results of its 2022 Health at Work survey. They queried 800 workers at companies that had at least 100 employees about what kind of health plan benefits would encourage them to stay with their companies. They were also asked to weigh in on at-home healthcare. Although the majority of respondents (nearly 90%) believe health screenings and wellness initiatives are important benefits, they had concerns about privacy and how much their employer might be learning about an individual’s health. More than two-thirds of workers didn’t want their employers to know the results of health screenings, and more than half had concerns about employer involvement in patient healthcare. Employees are enthusiastic about at-home testing including biometrics and felt they would take advantage of more screenings if they could do them at home. A majority said that telehealth was a desirable benefit.

Remote monitoring is an exciting technology, but a recent article in JAMA Internal Medicine questions the outcomes of remote monitoring in managing heart failure patients who have been discharged from the hospital. It should be noted that the study was small – 290 men and 262 women – and the mean patient age was 64.5 years. The participants were randomized either usual care or to remote monitoring of medication use and weight management with financial incentives for adherence. The primary outcomes were time to hospital readmission and death. Researchers found that there was no significant difference in outcome scores over 12 months.

Personally, I’d like to see some slightly different research. For example, what does the data look like for using remote monitoring to prevent hospitalizations in the first place? Is the data different for patients in different parts of the country since this study was done regionally? I’d also be interested to understand how much patient involvement was present in the remote monitoring, and whether outcomes are better if patients have to be more or less involved in the monitoring.

The best article I saw this week was this: “Effect of Genre and amplitude of music during laparoscopic surgery.” Researchers proposed that since music is often present in the operating room, they’d like to examine the effect of different types of music and different volumes on surgical performance. The research subjects were “novice surgeons” who were measured on their performance of laparoscopic surgical techniques. Music was either soft rock by the Beatles or hard rock by AC/DC and was played at medium or high volume. Surgical task performance was measured on speed and accuracy. Those hearing soft rock at medium volume were faster and more accurate than doing those tasks without music. When the soft rock was played at high volume, the improvements were lost. Hard rock at medium volume led to faster precision cutting compared to no music. Hard rock at high volume also led to increased speed. The authors concluded that “our data reveal that the effect of music… might depend on the combination of music genre and amplitude. A generally well-accepted music genre in the right volume could improve the performance of novice surgeons during laparoscopic surgeries.” I discussed with my surgical colleagues and they would like to understand whether outcomes are different for experienced surgeons, but no one is ready to draft a research proposal just yet.

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Shoes of the week: This sassy shoe-sock combo was spotted a conference tweet. They look very comfortable and I’m a sucker for sparkles, so if anyone has the details on these, I’d love to know where I can get a pair.

What’s your go-to slip-on shoe? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/12/22

May 11, 2022 Headlines No Comments

Health Catalyst Acquires ARMUS; Bolsters Clinical Quality Offering and Outsourced Services

Data and analytics software vendor Health Catalyst acquires Armus, which offers clinical registry development and data management services.

HHS Announces $16.3 Million to Expand Telehealth Care in the Title X Family Planning Program

HHS allocates $16.3 million to Title IX family planning clinics for expansion of telehealth infrastructure.

Bon Secours Mercy Health Introduces Accrete Health Partners

Bon Secours Mercy Health (OH) launches Accrete Health Partners, a holding company that will focus on streamlining the health system’s digital health services, partnerships, and investments.

Handspring Launches with $6.2 Million in Seed Financing To Make Quality Mental Healthcare More Accessible to all Children and Families

Hybrid pediatric mental healthcare startup Handspring Health raises $6.2 million in funding.

HIStalk Interviews Kevin Coloton, CEO, Curation Health

May 11, 2022 Interviews No Comments

Kevin Coloton, MBA, MPT is founder and CEO of Curation Health of Annapolis, MD.

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Tell me about yourself and the company.

We formed Curation Health in 2018. The primary objective is that the recognition that value-based care is extremely complex, and often a more difficult transition for organizations to take migrating from fee-for-service than many expect. It is particularly challenging for the providers at the front line of care delivery. 

We are obsessed with solving for the experiences that our end users need. In our case, that’s the providers and the support they need to have sustainable success in value-based care. We recognize who they are and what they need, and we design tools and solutions to make it easier for providers to do the right thing when engaged in value-based care activities.

The end result of that is we have built a clinical decision support platform that facilitates provider workflow with the goal of elevating care delivery and receiving the appropriate clinical and financial outcomes for good work being performed.

I’ve had the great privilege of working in the healthcare industry for the past 25 years in various roles. Specifically, in patient care as a physical therapist, hospital administrator, management consultant, technology executive, and entrepreneur. I’m also fortunate that we have been able to assemble a team at Curation Health of industry veterans that have served organizations in health technology, consulting, and value-based care for a long time. They hail from organizations like Evolent, Optum, and The Advisory Board Company in Clinovations. In many cases, I’ve had the great privilege of working with a host of my colleagues for a very long time.

We’ve heard for years that value-based care is just around the corner, but most providers continue to make most of their revenue and profit from fee-for-service. How will that change?

The evolution of value-based care is slower than many expected, but is making progress. One of the most interesting, catalyzing events has been COVID and the pandemic. If patient volumes decrease in a purely fee-for-service environment, the clinical and financial implications of care for patients is pretty significantly impacted. Many organizations have recognized the need, despite the fact that they have a primary focus on fee-for-service. A balanced portfolio across fee-for-service and value-based care makes good sense to allow organizations to have sustained success.

We are seeing the march to value-based care taking a dramatic turn in the last nine months, where organizations are seeing appropriately that they need to start building the infrastructure and participating in value-based care. In some cases in their regional and local markets, the health plan and provider collaborations have greatly encouraged migration to more value-based care. It’s an important effort for almost all organizations, regardless of their payer mix, to have begun investing in value-based care infrastructure, capabilities, and knowledge.

How do the clinical decision needs of providers change as they start to see patients under a value-based care arrangement?

When you reflect on what’s different between fee-for-service and value-based care, most organizations today — unless they are purpose-built for value-based care — rely on a fee-for-service infrastructure. Their operations, their scheduling process, their patient contact. Even the clinical operations themselves of registration, check in, rooming the patient, seeing the patient, and allocating time for visits are all very different if you’re in a fee-for-service environment versus value-based care. 

The provider challenge is that they are attempting to have more intensive, longer value-based care interactions with patients where they are reviewing the complete chart and trying to prioritize, what is the clinical focus for our time today? They are balancing that with fee-for-service interactions, which are typically 10 minutes or less and focused on the reason for the visit. Why is the patient here today? Certainly they take care of other healthcare priorities as well, but it’s a very different mindset and operational approach.

Our goal is to simplify, to take some of that cognitive load away from identifying which patient is in front of me today. Which plan are they associated with? If they are in a value-based care arrangement, what should be my clinical priorities to address today for this patient, oriented to the highest clinical impact? If I only have time to do one thing today, what’s the most important thing for me to do? Or, what are the top two priorities I should focus on to achieve with this patient today?

The other big transitional difference is that value-based care is managing thousands of patients over a calendar year. Fee-for-service is typically prioritized and focused on, what are the priorities for the 30 patients I have scheduled tomorrow or the patients I have scheduled across the next few days? It’s a pitching and catching delta, where value-based care is a strategic approach across the calendar year and fee-for-service has a tendency to be more reactive, where patients are coming to the clinic, in the home, or in a telemedicine visit with a particular urgent or emergent need or acute need. Those are very different operational approaches. We aim to simplify that.

The technology requirements of that “feet in two boats” situation, where a given patient may be covered by fee-for-service or a value-based care arrangement, must be complex.

Massively complex. The attribution of patients alone is a massively complex undertaking. Which patients in my care are mapped to which value-based care program? We have some clients that have four, five, or six different value-based care contracts with different health plans. That complexity is massive.

Our goal is to greatly simplify that by having the provider focus on one simple workflow, and have that workflow be agnostic to whatever plan they’re mapped to. We focus our technology to simplify, to say that “this patient has these priorities that would benefit from being addressed in this interaction for the provider” instead of the provider trying to figure out which health plan it is, and of that plan, which subset a VBC contract is aligned with that. What have I already taken care of this calendar year? We seek to greatly simplify it by producing insights that are prioritized by clinical impact and greatly simplified into the handful of items that the provider can take care of to maximize the health of the patient.

In some cases, they are not even aware of which value-based care contract that patient is mapped to, because they don’t need to be. Their focus is on rendering awesome clinical care for the patient. Having one simple workflow enables them to focus on what matters, which is, this patient needs my help in these areas.

The healthcare technology industry has a tendency to focus on what we describe as data maximalism, which is this mindset that bigger is better. It’s really the identification of massive amounts of data that holds limitless potential value, and it’s candidly the easiest and most exciting approach to take. You can use incredibly modern and precise technologies to harvest a tremendous amount of data at a patient level or across your whole community of patients you’re serving. 

When we launched Curation Health in 2018, we learned the hard lesson of having a data maximalism approach. The problem is that when you’re analyzing a massive amount of data — and in our case, we also compile this dataset with human review to find more and more items of opportunity — the results we found were counterintuitive. The more accurate and voluminous the data that we found and sent to providers, the less they acted on it. 

We quickly learned that the value is not on the potential of this information and what it could do to transform provider success. The only thing that matters is what information they are going to use when managing a patient’s health. Therefore, we came to this realization that value-based care, healthcare technology analytics and reporting, and clinical decision support are not really technology problems to solve. It needs to be a clinical workflow problem to solve. How do you make it easier for the provider to do the right thing?

We evolved this concept of data minimalism, which in our mind is the minimum dataset required for a provider to use to enhance the health of their patient. Instead of bigger is better, which is the data maximalism approach, data minimalism is that less is more. Once we prioritized and contextualized the information that we were sending to physicians, we saw adoption and use skyrocket. It was a really powerful lesson for us. It revolutionized the way we design our technology platform, how we build our user interface, and how we choose the information that we are serving. It made it simpler for providers to act. We learned more and more of the power of simplicity and the direct correlation with provider adoption and use.

How much detail and complexity is contained in a provider’s value-based care contract that is translated into plan-specific clinical decision support?

The contracts themselves are incredibly complex. They are very different from agreement to agreement. Some prioritize risk adjustment performance HCCs and related measures, RAF particularly. Some prioritize quality, HEDIS, and Stars. It is very dependent on the region, the health plan, and the provider partnership. Because of that, we spend a lot of time with our clients helping demystify the agreement that they are participating in. What would be the analysis of the return on investment clinically and financially for the organization? What are the KPIs that the provider group needs to focus on to achieve the results they’re hoping to achieve? If they have limited time, where would they emphasize their focus and dedicate their attention to serving particular metrics, measures, or activities that help everybody win in this equation?

The premise with this equation is that if we can prospectively manage the patient’s health and outcomes, then we can improve their health, and everyone wins in this model. The health plan, the provider organization, and ultimately the patient. The goal is to also understand that this particular value-based care contract prioritizes certain investments of energy and time and making sure that everybody is aware of those and keeping appropriate attention on those items.

How does the pre-visit review differ under a value-based care arrangement?

I had the great privilege of running ambulatory clinics for a period of time in a predominantly fee-for-service environment, so I have a good sense of how that works. The value-based care pre-visit activities are dedicated to figuring out ahead of a clinical interaction, what are the top clinical priorities that this patient is challenged by? Then, focusing the provider attention on those priorities.

In the traditional model, physicians would quickly scan the chart and go into the room, if it’s a clinic setting, and ask the patient something along the lines of, “What brings you to see me today?” to make sure that they are aligning what they see as the priorities with what the patient priorities are. That’s good practice.

In a value-based care world, it’s a little more complex, because you have to understand what you’ve already done that calendar year. What items remain to be managed? Also, what are the priorities that you haven’t yet covered with the patient that would greatly improve their health and wellness? 

That concept of pre-visit is leveraging good technology to discern clinical opportunities from the thousands and thousands of lab values, radiology reports, HIE data sets, EMR data, and claims data and narrow it down to a specific set of high priority items that the patient would benefit from having managed. In some cases, the pre-visit review also involves a human reviewing the output of the technology or the reports to further refine the data that gets to the physician. Ultimately, the goal is that when the physician enters the room with the patient, they are well aware of the clinical priorities that need to be addressed, but they also have the context as to why these are priorities.

One of the big challenges of working in a fee-for-service and a value-based care world is that providers are challenged by capacity, time, and resources in most cases. They have limited time with the patient. They may not have a lot of technology tools or humans to participate in that pre-visit analysis. So when they review the clinical opportunity while sitting in front of the patient, they often don’t have enough time to validate them, to go through the EMR and understand when this lab value is drawn and what this comorbidity and this medication might lead to. The goal with pre-visit is to take all of that clinical administrative research and have most of it conducted before the patient is being seen by the provide so that the provider is able to focus their attention on validation and action rather than just pure research.

Do patients know that they are being covered by a value-based care arrangement? Do they need to be educated about their role in it?

It varies. In some cases, patients are well aware of the program that they are participating in. They are able to make determinations of which network they want to participate in or who the provider group they want to have administering their care. In other cases, it’s more of an administrative function that happens in the background, and patients may or may not be aware of it or have much information or insight into what it means and the potential delta of how the physician may be managing their clinical interaction.

I think Medicare Advantage has become the largest area of focus in the value-based care realm. A lot of patients are becoming more understanding of why it’s important to have more of a prospective care approach than a retrospective care approach or a fee-for-service, real-time engagement. 

It definitely varies by region, by plan, and by other elements. But I have seen many cases where patients are very aware of it. I think you’re right, though, that the onus is on the provider, the practice, the organization, or the health plan to educate the patient as to the change in the model of care being delivered. From the feedback we hear, patients have appreciated the value-based care approach, because it feels like their care is being holistically managed and sometimes a bit ahead of time. We are biased, but we believe it’s a better model of care delivery where you’re trying to anticipate future need by focusing on current challenges and engaging the patient in that journey more directly.

What factors do you see impacting the company’s strategy in the next three or four years?

Several elements are going to be impacting our strategy. We highlighted one of them at the beginning of our conversation, which is how quickly organizations are adopting value-based care. Some organizations are in the early phase of their journey, while others have been doing this for some time. That progress directly impacts our ability to serve and elevate performance for those organizations. The ever-changing nature of the value-based care design model and contracts definitely are impacting how we do what we do. Every year we are constantly scanning regulatory changes. Compliance is a huge priority for us. Our clients are relying on us to greatly focus on that. We need to be very current, and the only constant in the value-based care structure to date has been change.

The other element is care model delivery has been greatly changing. We’re having a real increase of organizations focused on in-home primary care, in-home specialty care, and virtual care. How all of those align with value-based care models has been interesting and fun for us to design and partner with. I think that will keep us busy for some time.

Morning Headlines 5/11/22

May 10, 2022 Headlines No Comments

Harris Completes Purchase of Allscripts Hospitals and Large Physician Practices Business Segment

Harris rebrands the hospital and large physician practice software business it acquired from Allscripts to Altera Digital Health.

Med-Metrix Announces the Acquisition of PatientPal, Bolstering the Company’s Front-End RCM Software and Service Solutions

RCM solutions vendor Med-Metrix acquires PatientPal, which offers patient engagement and front-end RCM software.

Omnicell Discloses Some Systems Affected by Ransomware

Omnicell reports that a ransomware attack last week impacted some of its systems, adding that customer operation of its medication management devices was unaffected.

Osmind Raises $40M Series B Round Led by DFJ Growth to Expand Platform for Breakthrough Mental Health Research and Treatment

Mental health EHR and research startup Osmind raises $40 million in a Series B round that brings its total funding to $57 million.

News 5/11/22

May 10, 2022 News 4 Comments

Top News

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Harris rebrands the hospital and large physician practice software business it acquired from Allscripts to Altera Digital Health.

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The business’s president will be Marcus Perez, MS, MBA, senior EVP of Harris Healthcare.

The $700 million acquisition, which closed May 2, included Sunrise, Paragon, TouchWorks, Opal, Star, HealthQuest, and DbMotion.

Allscripts has not removed the divested products from its website or announced how its developer program and App Expo will work post-acquisition.


HIStalk Announcements and Requests

Pondering: is intelligence deficit disorder, as evidenced by Facebook postings, a pandemic? Or, does Facebook attract a disproportionate number of users who can’t express a cohesive thought, use the Internet without help, or resist adding opinions even when they are irrelevant or poorly considered?


Webinars

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


Acquisitions, Funding, Business, and Stock

RCM solutions vendor Med-Metrix acquires PatientPal, which offers patient engagement and front-end RCM software.

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Mental health EHR and research startup Osmind raises $40 million in a Series B round that brings its total funding to $57 million.


Sales

  • Novant Health (NC) will implement Infor’s cloud-based healthcare ERP software with consulting help from Grant Thornton.
  • ScionHealth selects R1 RCM’s software and services for its 61 long-term acute care hospitals.
  • In the UK, NHS Lancashire and South Cumbria will implement Citadel Health’s laboratory information management system in $12 million project.
  • Cleveland Clinic chooses Medically Home Group to develop a program to care for acute and post-acute patients at home via a virtual command center.

People

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Martin Spence (Fujifilm Medical Systems) joins Clearwater as virtual CISO and principal consultant.

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Telstra hires Monica Trujillo, MBBS, MPH (Cerner) as chief health officer.

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Instamed, a J.P. Morgan Company hires Steve Sewell (Optum) as executive director of product management.

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Brett MacLaren, MBA (Providence) joins Kaiser Permanente as SVP of data and analytics.

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B.well Connected Health hires Nathan Weems, MBA (VitalConnect) as CFO.


Announcements and Implementations

Patient engagement software vendor PatientTrak announces GA of digital patient intake forms for outpatient facilities.

IatricSystems launches DetectRx drug diversion and automated evidence-based response software. Iatric was acquired by Harris in 2018.

Interbit Data launches Beacon, an enterprise care continuity solution that addresses downtime, including cybersecurity incidents.

Advance care planning organization Five Wishes creates a lifetime digital version of its advance directive, which will be stored on Vynca’s advance care planning platform.


Government and Politics

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A survey of 701 DoD providers finds that 58% have identified inaccurate or incomplete data in the agency’s Cerner-powered MHS Genesis system, leading to inaccurate, delayed, or incomplete diagnoses; multiple patient visits to complete care; and longer patient visit times. Medical device integration with MHS Genesis was also found to be problematic, with respondents noting that “…eye care devices are not connected to the system and this creates significant delays and repeat imaging,” and “the process to get medical devices connected is CONTRARY to 21st century healthcare delivery. We just choose to ignore that equipment isn’t connected.”

Government-run psychiatric treatment provider directories — such as SAMHSA’s FindTreatment.gov that was intended to give patients a better option than having their Google searches exposed to marketers — contain outdated and incorrect provider information. Patients report reaching disconnected numbers, contacting facilities that aren’t accepting new patients, or finding that clinicians have retired or moved. The directory does not vet submissions beyond verifying licensure and does not include quality indicators.


Other

Apple retires my once-beloved IPod Touch, marking the end of the 20-year-old IPod line. Other IPod models along the that have been largely forgotten – I think I’ve had and/or gifted them all multiple times — were the Mini, Nano, and Shuffle. The Touch, ownership of which I bragged on starting in 2010, was basically an inexpensive IPhone without the “phone” part and free of ongoing cost, capable of just about anything as long as a WiFi connection was available.


Sponsor Updates

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  • AGS Health leaders work with United Way to create handmade educational kits for underprivileged students.
  • Agfa HealthCare profiles a new customer success story, “Enterprise Imaging supports successful major transformation at Ziekenhuis Oost-Limburg (ZOL), Belgium.”
  • The First Coast Worksite Wellness Council recognizes Availity with its Healthiest Companies Platinum Level Award for the eighth year in a row. 
  • Baker Tilly releases a new episode of its Healthy Outcomes Podcast, “Key factors and trends impacting M&A activity in the healthcare industry.”
  • Delaware documents 100,000 referrals in the third year of its use of Bamboo Health’s OpenBeds referral network.
  • CareMesh names Martin Armitage (NaviHealth) director of strategic accounts.
  • CHIME and more than 100 additional healthcare organizations sign a letter urging Congress to removal the ban on funding for a national patient health identifier standard.
  • Interbit Data launches the next generation of its Beacon Platform, designed to help hospitals with communications and care continuity during downtimes.
  • Ellkay will exhibit at the NEHIMSS Spring Conference May 12 in Norwood, MA.
  • PerfectServe honors over 130 exceptional nurses in its second annual Nurses of Note Awards program.
  • Wolters Kluwer Health adds diversity, equity, and inclusion content to its Ovid medical research platform.
  • WebPT adds PVerify’s Advanced Eligibility solution to its EHR for physical therapists.

Blog Posts


Contacts

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

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Morning Headlines 5/10/22

May 9, 2022 Headlines No Comments

CareCloud Reports First Quarter 2022 Results

CareCloud reports Q1 results: revenue up 19%; adjusted EPS of $0.23 vs. $0.19, beating Wall Street expectations for both revenue and earnings.

AMIA and HL7 Announce Partnership to Advance Interoperability in the Healthcare Community

The American Medical Informatics Association and Health Level Seven International will work together over the next two years to further interoperability standards.

Upswing Health, Whose Condition-Based Musculoskeletal Healthcare Eliminates Systemic Waste, Closes $5 Million Seed Round

Founded by orthopedic surgeons in 2017, virtual MSK care startup Upswing Health secures $5 million in seed funding.

Readers Write: Clinical Trials and the Data Diversity Problem

Clinical Trials and the Data Diversity Problem
By Liz Beatty

Liz Beatty is chief strategy officer for Inato of Guilford, CT.

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Minority and marginalized communities have historically been underrepresented in dozens of private sectors globally. This includes pharma, where there exists a steep chasm that drug makers have yet to bridge concerning research and trials – a chasm that directly impacts the quality, quantity, and diversity of data that determine the efficacy of a drug and its applicability to broad patient populations.

One needs to look no further than a retrospective review of 302 drug submissions to the FDA to find evidence of data problems. That review found that nearly 16% of submissions had insufficient data to determine safe dosages, more than 11% had inconsistent results between study sites, and about 13% failed to demonstrate statistically significant benefits. These findings suggest data limitations, including diversity, influence the FDA’s rejection of five out of six submissions.

The longer the trend of incomplete data exists, the harder it becomes to address. The feelings of mistrust, resentment, and disenfranchisement only get more complex to overcome with time. While there has been a concerted push by the pharmaceutical industry to improve the situation over the past decade, it’s not moving fast enough toward a solution.

The time has come for technologies to step in and innovate solutions for this situation once and for all.

Significant progress has been made in the public sector, particularly among studies funded by the National Institutes of Health (NIH) and the National Cancer Institute (NCI). However, the same cannot be said for industry-funded studies. For example, NIH requires grant applicants to include plans for recruiting women and members of minority groups, while the FDA released guidance focused on expanding eligibility criteria for such trials and discouraging unnecessary patient exclusions, as well as boosting the recruitment process in order to attract diverse patients. NCI also reported a 14% increase in minority participation among clinical trials it has funded over the past decade.

Among private-sector trials, however, little progress has been made with regards to inclusivity and diversity. The FDA reports that 75% of enrollees in trials for drugs it had recently approved were white, while just 8% were black and 6% were Asian. An NCI-funded study found that 9% of those participating in its SWOG Cancer Research Network trials were black, compared to fewer than 3% in trials sponsored by pharmaceutical companies. 

Nor is the diversity problem limited to race. Under-representation also extends to gender and even disease. For example, just 8% of cancer patients enroll in cancer trials, and less than 2% of cardiovascular disease trials reported any female sex-specific cardiovascular risk factors.

Historically, one barrier has been a lack of medical facilities with the capacity to host clinical trials in underserved areas. One NCI study found that 75% of patients don’t participate in trials simply because there are none in their area. Additional barriers for underserved patient populations included distrust of clinical trials, insufficient information about the participation process, limited time and/or resources, and lack of awareness.

The resulting lack of diversity impacts sponsors and clinical trials in three key areas:

  • Accurate, robust data. The scientific method is null and void when data sets are incomplete. Yet a multitude of clinical trials continue to enroll smaller, homogeneous groups of patients who predominantly reside within a short travel distance of major trial sites. This should ring alarm bells for any drug maker seeking the efficacy and side effects of the medications they intend to bring to market. Incomplete data is a risk to the patient and treating physician, and it’s a financial and reputational risk to the business.
  • Trial efficiency. Including broader demographic and geographic groups can accelerate trial speed and boost efficacy, while testing on a narrow participant group can result in unanticipated results after approval. Additionally, pharma companies that run fully representative trials are likely to experience greater success in reaching FDA approval for their medications.
  • Financial incentives. Greater patient participation enables speedier trials and reduces costs, while a wider prospective candidate pool can reduce recruiting time, which drives down opportunity costs associated with delays that can run from $600,000 to $8 million per day. Further, better detection of side effects that might otherwise be missed when enrollment is limited — resulting in an incomplete picture of the treatment’s actual impact on the broader population – can prevent post-approval FDA black box designations and millions in lost revenues.

Increasing diversity and minority recruitment requires more than simply making a greater number of trials available in underserved areas; it also involves increasing engagement by partnering with community sites, using digital tools to enhance accessibility, and employing a diverse staff to better translate trial information to broader patient populations, all of which can be accomplished by embracing community-based research centers.

Powered by advances in remote patient monitoring and telemedicine technologies, decentralized trials and distributed testing eliminate physical and geographic boundaries. When these technologies are combined with cloud-based marketplaces to connect trial sponsors with underutilized community sites and provide those smaller sites with additional enrollment support, the patient pool expands significantly. A larger patient pool allows investigators to recruit a more diverse and representative patient population, improving data quality, avoiding delays, lowering costs, and accelerating FDA submission and approval.

The benefits of trial diversity are apparent. And while steps have been taken in the right direction, there is always more to be done. The benefits of doing so, however, are clear. Prioritizing community sites and recruiting for and implementing equitable, inclusive clinical trials can have a significant impact from both a scientific and ameliorative standpoint.

Readers Write: Are HCC Codes and RAF Scores Enough?

May 9, 2022 Readers Write 1 Comment

Are HCC Codes and RAF Scores Enough?
By Sara Pastoor, MD

Sara Pastoor, MD, MHA is director of primary care advancement for Elation Health of San Francisco, CA.

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The introduction of electronic health records (EHRs) has ushered in an age of data-driven capabilities that hold great potential to alter healthcare, both as an industry and at the front lines of care delivery. EHRs have apparently disrupted everything, for better or for worse. Well known are the complaints that the EHR has inserted a wall of hardware and electrons between doctor and patient, not to mention the documentation burden that has often decreased revenue by slowing the pace of care and adding hours to a physician’s work week. Yet EHRs capture, organize, and store large volumes of health information that can now be leveraged in unprecedented ways to help payers, providers, and patients all win.

One of the most transformational results of this data and information boom in healthcare is the ability to analyze the medical complexity of a patient population and use that analysis to inform resourcing and care. Sicker patients need more and different things than healthier patients do. Historically, a primary care doctor was paid relatively the same amount of money whether caring for a patient with one chronic condition or five. Today, the data encoded into EHRs can be leveraged in specific payment arrangements to justify higher reimbursement rates for sicker patient populations, with bonuses for delivering better care through reporting on defined quality metrics.

The most common example of this involves Hierarchical Condition Categories, or HCCs, which are part of a model for risk stratification originally designed by CMS in 2004 to predict future healthcare costs for patients. Each condition category, which is based on ICD-10 codes, is combined with a set of demographics (gender/age) to assign patients a Risk Adjustment Factor or RAF score. RAF scores are based on demographics and disease burden (determined by ICD-10 codes), and are used to adjust quality and cost metrics by accounting for differences in patient complexity. Using this scoring system, payers in capitated payment arrangements can provide higher payments to primary care practices with more complex patient populations. Payers can also use these scores to determine performance-based metrics and bonuses, by identifying patients with specific expected care needs based on gender, age, and chronic condition.

In value-based payment models, RAF scores work pretty well for getting paid. However, the concept of risk adjustment and stratification carries much greater potential beyond cost estimation and reimbursement structures. It carries tremendous power to improve outcomes and decrease total cost of care. While it is critical to compensate care teams for the resources required to properly manage complex patients, more enhanced risk adjustment models based on predictive analytics enable clinical interventions that change lives.

Consider my patient, who we’ll call Albert. Albert is a 72-year-old with diabetes, hypertension, obesity, obstructive sleep apnea, and chronic venous insufficiency. His wife died after a sudden and short battle with cancer. His diabetes and other conditions were previously well controlled, but he had one prior episode of venous leg ulcer complicated by cellulitis requiring a hospital admission in the past year. Following the death of his wife, Albert started to forget to take his medications, use his CPAP device for his sleep apnea, and wear his compression stockings for his venous insufficiency. His bereavement made it difficult for him to cope, and he began to neglect his care.

Additionally, his wife had been the one to check his feet for calluses, wounds, or infections since he could not reach them,  an important daily ritual for diabetics. Without his wife to cook for him, he began dining out more often, frequently defaulting to fast food. His weight increased, his chronic conditions spiraled out of control, and he developed a diabetic foot ulcer that went unnoticed until infection had invaded the bone, eventually requiring a partial foot amputation.

Albert’s diagnoses of diabetes, hypertension, obesity, sleep apnea, and chronic venous insufficiency make up a common constellation of conditions. Every family physician in America manages many patients like Albert. Yet Albert’s ICD-10 codes, age, and gender do not alert us to his quite predictable and extremely high risk of at least one bad outcome in the very near future. Albert’s RAF score is equal to that of every other patient with his same demographics and ICD-10 profile, but Albert is a ticking time bomb. With extra support and appropriate interventions, Albert’s diabetic foot ulcer, osteomyelitis, and subsequent partial foot amputation were entirely preventable, if only we had known.

HCC codes and RAF scores are a blunt instrument for managing a population. Patient complexity and the corresponding patient needs are far more nuanced than ICD-10 codes and demographics would suggest. Determining which patients need what interventions is a delicate and sophisticated science. Furthermore, the CMS HCC/RAF model does not generalize well beyond the Medicare population, and there is a need to manage clinical risk across all types of patients and ages.

To achieve the level of insight needed in a risk adjustment model for targeted population management, the model needs to factor in a number of additional determinants. My suggestions include functional status, severity of illness, the interplay between diagnoses and treatments, historical utilization patterns, pharmaceutical costs and risks, number of subspecialists involved, and social determinants of health. This more nuanced risk stratification serves to better inform the true risk of each patient, producing actionable information clinicians can use to intervene and make a difference for those who need it most.

In Albert’s case, his combined conditions of diabetes, obesity, and chronic venous insufficiency dramatically increased his risk of chronic limb ulceration and corresponding complications due to the interplay between these three conditions. According to scientific evidence, his prior history of venous leg ulcer with infection placed him at even higher risk of repeat hospitalization for a similar event. His bereavement, a pivotal life event, predictably increased his risk of worsening severity of illness for his baseline conditions. Exacerbation of his sleep apnea due to poor CPAP compliance predictably worsened his diabetes, hypertension, and obesity, even if he didn’t struggle with medication compliance and worsening of his diet. This complex interplay of factors had a dramatic effect on Albert’s health status, not reflected in a RAF score.

Sophisticated risk adjustment models are very effective at plucking patients like Albert out of the crowd and identifying him as high risk/high need. Evidence-based clinical interventions could very likely have spared Albert both his foot and significant mental anguish, also saving his health plan a chunk of change. If we apply this illustration to thousands or even millions of patients, the potential impact to the healthcare system and more importantly to society is staggering.

I envision a world in which the EHR has an integrated advanced risk adjustment model that alerts care teams to patients like Albert. Running in the background of an EHR platform, these analytic models can identify patients who are at highest risk of a health crisis and drive actionable information into the primary care workflow where care teams can not only intervene, but also capture their work for measuring, reporting, and follow up. This is a powerful intersection between technology and the physician-patient relationship for which rudimentary HCC/RAF coding falls short.

Any patient would be grateful to avoid hospitalization or a trip to the emergency room, but the benefits of such analytic tools go much further. This is the Quadruple Aim in action, with meaningful impacts to patient experience, provider experience, outcomes, and cost of care. In a payment arrangement involving shared risk, primary care is positioned to drastically reduce total costs of care with such technology while reaping significant financial benefits for doing this work. Often, the extra clicks and associated tasks related to EHR alerts for HCC reporting feel like administrivia, lacking direct clinical impact to the patient. Alerts that directly result in meaningful clinical intervention feel like time well spent. Payers win, providers win, and patients win.

Albert had interacted with the healthcare system both while his wife was dying and after his bereavement. His history of hospitalization for venous leg ulceration sat right there in his claims data. His poor CPAP compliance was transmitted wirelessly to the DME company managing the settings on his device. The information necessary to predict Albert’s escalating risk was known, but the systems and processes were not in place to identify his risk and notify someone who could do something about it. I learned about his unfortunate health debacle when he came to me with an advanced foot ulcer, well past the window of opportunity for meaningful intervention.

I have so many memories of patients over the decades for whom the trigger(s) leading to the trip down disaster lane toward catastrophic health outcomes only became obvious in retrospect, because we didn’t know what we should have known, so we couldn’t do what we should have done. We have the technology to do better. When we start putting that technology in the hands of primary care, lives will change.

Curbside Consult with Dr. Jayne 5/9/22

May 9, 2022 Dr. Jayne 1 Comment

I spent a good chunk of the weekend outdoors, enjoying some quality lakefront time while spring is here. Despite the copious pollen, it was still much more enjoyable than when summer hits and you’re debating whether the humidity or the mosquitoes are more oppressive. Still, when I got home, my tent needed a full wash to get the pollen out, and my quick air out took a little more time than planned. Waiting for it to dry before I could finish packing up all my camping gear gave me an opportunity to complete the Continuing Medical Education evaluations that are required for me to get credit from my recent conference attendance, and to try to wade through all the email that accumulated while I was away last week.

I also spent some time today with my extended family, who wanted me to explain what it really is that I do for work. They know I don’t see patients in person right now, but think I see patients on Zoom, which is good enough for me. They don’t really get what a CMIO does though, or what clinical informatics is, and sometimes trying to explain that is difficult. I try to give examples of the kinds of projects I work on, but I think even those are sometimes hard for people to really understand.

The one thing that usually resonates is when I talk about coaching physicians how to better use computers when they’re seeing patients. That understanding is usually accompanied by one of two stories. The most common story used to be that their doctor spends too much time looking at the computer and not at them. That’s becoming less common, which is a good thing. Now I hear a lot more stories about people’s experiences messaging their physicians through patient portals, which is good as far as portal adoption.

I actually had a conversation about that topic a couple of weeks ago with an EHR colleague. We were talking about the ways that different healthcare organizations approach the idea of encouraging patients to sign up for their patient portals. Some organizations bend over backwards to get patients to sign up. They may have staff in common areas who use a kiosk to try to get patients enrolled, or they may initiate an activation process during the rooming activities in the exam room. If organizations have highly developed process for portal utilization, they benefit from having more patients activated. This could be a financial benefit through reduction in paper billing statements, reduction in the time it takes for patients to pay bills, or reduction in staff costs due to telephone volumes for patient messages and appointment scheduling.

Other organizations however are less aggressive, and it feels like they are just hoping patients will stumble upon the patient portal and decide to sign up. A third group of organizations seems to just want to make it easy for the patients to do the workflows that a patient portal brings to the table but doesn’t necessarily want to require patients to sign up for an account.

Although I totally understand wanting to make things easy for patients, I think that approach will ultimately undermine patient adoption. Why? Because I see it in other industries. I know plenty of people who will go online every month and pay their utility bills, but won’t take the time to complete the process of signing up for automatic bill pay. Having a streamlined monthly process reinforces the customer’s action and they’re willing to do it again. But they’re not making the logical leap to understand that they could spend five minutes once and never have to go to the website again, versus spending two minutes each month for the rest of their lives paying that bill.

Not to mention that by not starting to fully embrace the use of the patient portal, they’re not able to use features such as those that might help with health promotion and disease management. They may also be missing out on the bells and whistles of being a registered user, such as being able to serve as a proxy or delegate for the accounts of children or elderly relatives, which generally aren’t available in the more freestanding workflows. Every EHR vendor handles these workflows in a slightly different way, but I see quite a few moving in the direction of “portal-lite” functionality to try to streamline patient access.

One hospital administrator I spoke with a few months ago tried to justify the fact that his organization isn’t spending any money on portal enrollment or activation efforts by saying that “our patients won’t use it because of XYZ reason, so we don’t want to waste the effort.” I think he is sorely mistaken for a couple of different reasons. First, many of the reasons that are often cited are not necessarily valid. People often think that older patients won’t be willing to use patient portals and for those tech-savvy elders, nothing is farther than the truth. If a patient is following their children or grandchildren on social media, in my experience, they are likely to be willing to use a patient portal, especially if it makes communication with their physician faster or easier.

People also think that not everyone has access to a computer or smartphone, and although that’s true, the percentage of patients who have access to those devices is climbing. Looking at 2018 data from the US Census Bureau, 92% of houses had at least one type of computer and 85% had broadband internet. Smartphones were present in 84% of households where 78% had desktops or laptops and 63% had tablets.

When thinking about the access argument, the truth is this. You don’t need to have 100% adoption to have a successful patient portal initiative. Even if you can get a percentage of your patients to enroll, and a percentage of those enrollees become active patient portal users, everyone can benefit. Patients can take advantage of self-scheduling workflows, which frees up office or call center staff. They can receive test results quicker, which often reduces phone call volumes as patients try to follow up on results. They can access visit notes, patient education materials, and care plans, which can not only reduce phone calls, but might also contribute to improved clinical outcomes.

With all that potential, it’s difficult to understand why organizations are slow to push for patient portal adoption.

What is your organization’s current patient portal strategy? Leave a comment or email me.

Email Dr. Jayne.

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