Recent Articles:

Morning Headlines 7/2/20

July 1, 2020 Headlines No Comments

FCC Announces Funding Increase in Rural Health Care Program for Funding Year 2020

The FCC adds nearly $200 million to its Rural Health Care Program, which has helped providers in rural areas leverage broadband networks for telemedicine during the COVID-19 pandemic.

Samsung invests in genetics-focused telehealth company as coronavirus rages

Genomics telemedicine company Genome Medical raises $14 million in a funding round led by Samsung’s Catalyst Fund.

Evidation Raises $45 Million Series D, Hires CCO To Accelerate Commercial Momentum and Expand Into Virtual Health

Health data aggregation and research company Evidation Health raises $45 million and hires Sam Marwaha (Boston Consulting Group) as chief commercial officer.

Morning Headlines 7/1/20

June 30, 2020 Headlines No Comments

How hackers extorted $1.14m from University of California, San Francisco

UCSF pays a negotiated $1.14 million to ransomware hackers to regain access to servers in its medical school.

NexHealth Raises $15 Million in Series A Funding

NexHealth will use a new $15 million investment to further scale its APIs for EHR and dental practice management systems.

Optimize.health Raises Seed Extension Round to Scale Digital Health Offering

Ambulatory-focused remote patient monitoring startup Optimize.health raises $3.5 million in a seed round led by Bonfire Ventures.

News 7/1/20

June 30, 2020 News 5 Comments

Top News

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UCSF pays $1.14 million to ransomware hackers to regain access to servers in its medical school.

BBC gained real-time access to the price negotiations between UCSF and the customer service website (!!) of the hackers, which was used to negotiate the final payment amount.

The UCSF negotiator told the hacker that the university had been financially devastated by COVID-19 and offered $780,000 instead of the demanded $3 million, finally settling on $1.14 million.


Reader Comments

From TheRona: “Re: KLAS. Santa Rosa Consulting and The HCI Group have their scores temporarily suspended pending a ‘data integrity review.’ What’s the scoop?” I reached out to KLAS and received a statement from Adam Gale that I’ll summarize as follows. KLAS found during its routine data checks that an unnamed company was offering to boost vendor KLAS scores for a price via sample manipulation, sometimes falsely claiming to vendors to whom it was pitching that they were working in partnership with KLAS. KLAS says it immediately removed suspicious survey responses and data, also noting that few companies responded to the unnamed company’s offer.

From Buzzword Compliance Department: “Re: telehealth and telemedicine. Interested in the difference. Anyone care to elaborate?” I’ve seen unconvincing arguments that the terms mean different things, and I acknowledge the vast difference between “health” and “medicine” without the prefix, but I think usage has made the terms synonymous. It’s like EMR and EHR – we pretend to support “health” and use that term even though we really just care about the “medicine” part of delivering profitable encounters. I would say that telemedicine specifically refers to physicians practicing medicine from a location that is remote from the patient, while telehealth theoretically could involve other kinds of practitioners or non-professionals who are helping someone with health issues or even activities that don’t involve patients directly. Now let’s move on to “virtual visit” – is that video only, or does a telephone conversation, SMS message, or email exchange count? (I’m voting the latter).


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor RxRevu. The Denver-based company improves healthcare by supporting informed, consistent, and frictionless prescription decisions, partnering with the largest PBMs and payers to bring accurate insurance coverage and cost data into the prescriber’s EHR workflow. The company’s Real-Time Prescription Benefit cost transparency solution brings real-time patient- and pharmacy-specific information, such as cost, coverage restrictions, deductibles, and therapeutic alternatives. Prescription Decision Support promotes condition-appropriate prescribing and cost transparency to improve patient safety and satisfaction while reducing prior authorization work. The company is working with 2,000 health systems that use Epic or Cerner, and in the first five months of 2020, it processed coverage and cost information queries from 110,000 providers in completing 10 million transactions with PBMs. Thanks to RxRevu for supporting HIStalk.

I rarely edit or otherwise alter reader comments, but I’m reminding myself and readers of the significant exception – I don’t allow comments that accuse people by name of doing something illegal or immoral. I’ve edited or deleted a couple this week because it is not fair to allow someone who is anonymous to make unproven accusations about someone who isn’t, although sometimes the political ones fall into that gray area of “public figure” with some health IT relevance and I’ll let them slide.


Webinars

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


People

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Fortified Health Security hires Dave Glenn (CBI) to the newly created role of chief revenue officer.


Announcements and Implementations

New Zealand’s MercyAscot private surgical facility goes live with InterSystems TrackCare during the country’s COVID-19 lockdown, using Microsoft Teams and remote training tools to perform a virtual implementation.

Healthcare managed detection and response services vendor CI Security announces integration with Internet of Things and Internet of Medical Things security vendors Ord, Medigate, and Cylera.

AMIA changes its November 14-18 annual meeting to a virtual event.


Government and Politics

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DOJ charges Miami entrepreneur Jorge Perez and several co-defendants with fraudulently billing $1.4 billion in healthcare charges from his EmpowerHMS hospitals, netting him $400 million. Jorge Perez bought or took over management of 18 struggling, tiny hospitals and promised to save them by using them to bill out-of-state lab tests at rural hospital rates. One hospital in a town of 1,800 billed $92 million in lab tests in just six months. Insurers got wise and stopped paying for the tests, causing 12 of the hospitals to file bankruptcy and eight to close. Hospital employees reported that their electricity was turned off for non-payment, they were stuck with medical bills due to unpaid insurance premiums, and one hospital had its beds repossessed while patients were in them. One of the defendants is Seth Guterman, MD, who had developed software to maximize rural hospital billing and who is president and founder of Chicago-based EHR vendor Empower Systems.


COVID-19

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Anthony Fauci, MD tells the Senate’s HELP committee on Tuesday that he wouldn’t be surprised if the daily number of new COVID-19 infections in the US rises from 40,000 now to an eventual 100,000. He warned Sunday that the US may not reach herd immunity even if a successful vaccine is developed because so many people will probably refuse to take it.

CDC Principal Deputy Director Anne Schuchat, MD says it is no longer possible to bring COVID-19 under control in the US, with the daily record number of new infections making it impossible to control the outbreak with contact tracing and quarantine. She says the experience with coronavirus will be similar to the Spanish flu of 1918 and nothing will stop it until a vaccine is developed. Schuchat was a key CDC player in previous outbreaks of H1N1 and SARS. Meanwhile, HHS Secretary Alex Azar says the” window is closing” to use the only available tools to address COVID-19 – distancing and masks.

Morgan Stanley’s COVID-19 model says epidemic doubling time has worsened to 41 days from 46 days last week, with Texas and Florida likely to have uncontrolled spread within 10 days if they don’t take aggressive action.

Arizona reported 4,700 new cases on Monday, with the largest increase being those aged 20-44 who also make up 22% of hospitalizations. The state has re-closed bars and other businesses, prohibited gatherings of more than 50 people, and pushed back school openings until mid-August. Florida reported 6,000 new cases on Monday with a positive testing rate of 14.4%.

A Harvard-NPR analysis finds that while US testing has improved to about 600,000 per day, it would take 4.3 million tests per day, coupled with contact tracing and a focus on people in high-risk settings, to suppress the infection’s spread.

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The EU opens travel to its 27 countries starting Wednesday to residents of 14 nations whose 14-day COVID-19 infection rate per 100,000 people is as good or better than the EU average. Residents of the US will not be traveling to Europe for the foreseeable future.

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Texas Medical Center redesigns its ICU capacity report to reflect the ability of its hospitals to use flexible capacity, responding to concerns from Governor Greg Abbott, who said that the previously reported 100% ICU occupancy was unduly alarming people. Projected bed occupancy growth predicts a move to Phase 2 ICU capacity on Wednesday. The total number of admitted patients who tested positive for COVID-19 was stable for weeks at under 500 per day until May 30, when the number started its steep, steady climb to the current 1,500+. The state’s Phase 2 reopening started on May 18.

Researchers find an emergence of a condition they are calling Multisystem Inflammatory Syndrome in children who are hospitalized for COVID-19. Those affected have heart problems, coagulation disorders, and gastrointestinal symptoms.

Former FDA Commissioner Scott Gottlieb, MD says that rapidly increasing case numbers in high-population states like Florida, Texas, and California mean that half of the US population will have had COVID-19 by the end of the year even if the current rate doesn’t increase.

Two Texas friends got tested for COVID-19 at the same facility before spending two weeks camping with others, yielding the same result (negative) but wildly different charges – one who didn’t want to bother using his insurance paid $199 in cash, while his friend is now stuck with a $900 balance that remained from Austin Emergency Center after her insurance company negotiated down the original $6,400 charge. She then went to the local TV station, after which the facility predictably cancelled her balance due.

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A Michigan college bar that was allowing patrons to ignore distancing and mask requirements is linked to 107 new cases of COVID-19. Meanwhile, UW Health says that contact tracers are finding that a high percentage of newly infected COVID-19 patients in Epic’s home county of Dane were exposed from large gatherings in bars.


Other

Telehealth visit counts have steadily declined since their mid-April peak, dropping from 14% of all visits to less than 8% as the availability of in-person visits returned. Potential red flags in this finding are: (a) telemedicine visits were counted from scheduling software appointment types, which may not be reliable; and (b) the report counted percentage of total visits as in-person visits were increasing, which provides no insight into the change in the absolute count of telehealth visits.


Sponsor Updates

  • Johns Hopkins Medicine will add HCPro’s library of physician query templates to its physician query system from Artifact Health.
  • The Chartis Group publishes a new white paper, “Under Attack: Five Practical Steps to Thwart Increased Cyber Threats.”
  • Clinical Architecture makes available its presentation from HL7’s FHIR DevDays, “Data Quality in FHIR: Lessons from the Field.”
  • Ensocare welcomes Ashley Gorham (Medical Solutions) as an account executive.
  • Hyland Healthcare will use MedPower analytics and tools to manage end-user training on its enterprise information platform.
  • In Australia, MercyAscot implements TrakCare patient administration and billing software from InterSystems.
  • Dimensional Insight will sponsor the St. Jude Walk/Run Boston on September 26.
  • Health Data Movers hires recruiters Brett Kimes (Oxford Healthcare IT) and Durc Strand (Pivot Point Consulting).

Blog Posts


Contacts

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

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Morning Headlines 6/30/20

June 29, 2020 Headlines 4 Comments

Flexwise Health Completes Merger with Prescience Health

On-demand nurse staffing company Flexwise Health merges with predictive staffing analytics vendor Prescience Health under the Flexwise brand.

System shutdown puts hold on Tennessee COVID-19 report; far SWVA adds another case

The National Electronic Disease Surveillance System Base System suffers a system failure over the weekend caused by high volumes of data input, compromising the the State of Tennessee’s ability to accurately report COVID-19 data.

Healthy.io, Israeli maker of smartphone urinalysis tech, buys its largest U.S. rival

Smartphone urinalysis company Healthy.io acquires competitor Inui Health, formerly known as Scanadu, for $9 million.

Curbside Consult with Dr. Jayne 6/29/20

June 29, 2020 Dr. Jayne 1 Comment

Back in the early days of Meaningful Use and the beginnings of the transition from volume-based payments to value-based care, I used to be knee-deep in politics, legislation, and regulation. Over the years I gradually spent more time with my nose to the grindstone helping organizations figure out how to transform and adapt to what were then final rules. From there I moved into more technology roles, helping vendors tweak their offerings and helping clients optimize their implementation.

I got away from following legislators and the courts, but the year 2020 has brought all that back on my radar. Understanding how closely tied the US healthcare system is with the US political system, especially through lobbying by powerful interests, I’m once again following the US Supreme Court and US Congress more carefully, along with various parts of government that are responsible for promulgating rules, policy, and guidelines. It’s a different place to be in, but still within the CMIO wheelhouse.

The US Supreme Court was busy last week, and although I thought I understood the meat of the DACA (Deferred Action for Childhood Arrivals) program situation, I failed to fully appreciate its ramifications on healthcare. When thinking of those impacted by DACA, most news stories feature high school students, college attendees, or young people in the workforce who are concerned about being deported after being brought here as children. An article put out by the AMA notes that approximately 30,000 of the workers impacted by the DACA decision are in the healthcare workforce.

What would our healthcare delivery situation look like with 30,000 fewer workers, some of whom have skillsets that are in shortage? Those impacted include physicians, nurses, and pharmacists. Looking at just the physicians and physician trainees, they have the potential to care for anywhere between 2 and 5 million patients during the course of their medical careers. Our nation continues to have a significant nursing shortage, to the point where we bring in travel nurses from around the world to staff patient beds in many parts of the US. Many of the lower-wage jobs in large urban health centers are staffed by immigrants, and I’m sure some of them fall under DACA as well.

The Department of Homeland Security will be re-visiting this issue and providing documentation to try to have the matter heard again, since the decision hinged on some specific details. If they do, I’m sure the more than 30 healthcare organizations that submitted a “friend of the court” brief for this case will continue to advocate on behalf of those impacted by an additional consideration of the program. In the mean time, hospitals and healthcare organizations should work to gain a better understanding of the immigration status of their workers.

CMIOs have historically been a lightning rod for complaints about physician burnout since EHRs were the vehicles used to add additional documentation burden and cumbersome workflows as part of federal incentive programs. In more than one client situation, I’ve been pulled in to use this expertise to try to address burnout that’s being exacerbated by the ongoing pandemic. I never sought to be known as “the EHR guru and burnout expert,” but that’s how I was introduced the other day. Although I’ve helped a couple of organization streamline their workflows, mostly around ordering and results management related to COVID, I’ve been doing additional work on the organizational development side to help leaders work better with clinicians who can only be described as shell-shocked.

I feel validated every time I see an article about this phenomenon. The AMA wrote about it recently in a piece titled “Four ways COVID-19 is causing moral distress among physicians.” I’ve worked a string of back-to-back shifts at urgent care, which essentially has become the emergency department because people are afraid to go to the hospital and come to us instead. I even had a gunshot wound the other night who required a trip to the operating room, which freaked my staff out, but given where I did my residency training, didn’t make me blink.

Already existing physician burnout is being exacerbated by not only a lack of effective treatments for the COVID-19, but lack of adequate personal protective equipment, which receives zero media coverage but is do-or-die for most of us. Now we’re dealing with either an extended first wave or a nascent second wave populated by patients who refuse to social distance or wear masks but desperately need our help when they find out they’ve been exposed at the neighborhood block party or their child’s sports practice. Frankly I’m tired of exposing myself personally while trying to help patients who just don’t give a damn or who are all about instant gratification.

Today I had every room in the center fully utilized, some rooms with 2-3 patients in them as part of a family unit, and was still 10-deep in the waiting room (which was actually 10-deep with people waiting in their cars in 90-degree weather.) Fortunately, I had my favorite physician assistant to help me fight the battle and we kept each other’s spirits up. We could only be described as “medieval warrior meets LL Bean” since I was wearing a modified welding face shield that looked like I meant serious business, and she was wearing a face shield with plaid trim. Based on our shifting case mix, I’m once again isolating in a corner of the house mostly away from others, and I guess if it continues to get bad, I could always go back to staying in a tent in the yard.

At least I’m a fully trained physician and making the choice to expose myself to this craziness voluntarily, which can’t be said of the thousands of resident physicians who are staffing hospital beds and clinics across the country. Earlier this month, residents in New York staged a walkout at their Brooklyn hospital, sharing a list of demands they want met prior to a potential second wave. During the peak of the surge, residents felt alone and abandoned by their facility’s leaders, forced to cope with a lack of supplies and little recourse. I found the statistics in the article staggering, including the fact that by May, a whopping 70% of the emergency medicine residents had tested positive for COVID-19. Residents also cited 160 patients in an emergency department that was 100 patients over capacity. Needless to say, this is not ideal.

A couple of readers have asked why I focus so much on the “in the trenches” experience lately rather than writing about healthcare IT. In addition to it being what I’m living on a regular basis, it’s something that all of us on the technology side need to understand. Organizations are trying to roll out numerous solutions to help solve problems and make things smoother for us, but I truly believe that to be effective in that effort they need to understand where we are, physically, mentally, and emotionally. We’re not going to show up on a web-based training session when we’re post-call and exhausted, and if we’re not focusing on what a trainer is saying because we haven’t eaten in 10 hours and really need to go to the bathroom, it’s something that should be considered.

I’d be interested to hear from readers on how your organizations have modified rollout plans for new solutions or how you’re addressing changes to functionality while your end users are on the edge. Are you making tweaks to try to streamline systems, or are you staying static to allow people to focus on other matters? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Matt Wilson, SVP of Healthcare Strategy, Infor

June 29, 2020 Interviews No Comments

Matt Wilson is SVP of healthcare strategy for Infor of New York, NY.

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Tell me about yourself and the company.

I’m a healthcare IT lifer, with 27 years in the industry. It’s kind of a family business. My father was an HIT executive going back into the 1970s, so I have been in and around this business for my whole life. I am fascinated in the way it has evolved and I enjoy watching its trends. It’s a pleasure having the opportunity to participate.

Infor is a global cloud computing company with deep investments in industry-specific lines, executives, and products, such as Infor Healthcare.

How has adoption of cloud technology in healthcare changed?

Adoption of cloud technology gives us an opportunity to manifest a remote workforce, which we’ve seen through the pandemic, and we will see more of that. Cloud provides the ability to rapidly respond to customer needs with updates that don’t require the same kind of effort as on-site, on-premise solutions. We can engage our customers more consistently and more rapidly, which is an enormous benefit of cloud in addition to the reduced costs of maintenance.

Are you seeing a new urgency for agility in your customers since the pandemic started?

We are. Customers need us to be agile, especially in areas such as supply chain and real-time location services. Our objective has been not to get in our customers’ way, but simply to make ourselves available for what they need. We have found that our greatest opportunity to help has been engaging with something that takes a couple of weeks instead of the months and months that we’re used to with typical implementations.

How do you see the synergy between EHRs and enterprise resource planning systems?

Infor as a company, and I as an individual, are focused on how create a more balanced ecosystem. We have spent years and years, decades in fact, investing in EHRs. I was a beneficiary of that, as I helped build Cerner through the late 1990s and early 2000s. The lack of commensurate investment in ERP has created an imbalance.

We believe we can move the industry by modernizing the technology, driving a set of functionalities that contribute to the core mission of patient outcomes and a better system of health and wellness. You must have world-class systems and functionality across the core pillars of finance, supply chain, and human capital management. The way that we use interoperability and the way we orient ourselves to that core mission is critically important.

What is left to accomplish with ERP?

We need to bring together those investments to orient themselves to a single goal. We have tended to think about upgrades and technology as an ability just to upgrade the tech itself. The future holds orienting towards making one leverage off of the other, creating that ecosystem and integrating some of the billions of dollars we spend each year on management consulting on transformation. That transformation creates change. Tech should be used to sustain change. As you are moving forward with big transformation projects, how can you use your clinical solutions, your revenue solutions, and your business solutions to sustain the efficiencies, cost reductions, and tech advancement? That will be critical as we move forward, and we can play a big role in that.

As EHR and ERP vendors get bigger, does the opportunity still exist for smaller vendors to offer an ecosystem of wrap-around products?

Our Cloverleaf solution is the most widely implemented integration engine. True interoperability creates a wire that connects both traditional and nontraditional data sources and care venues, but should be used to facilitate small tech, where the gating factor for cool, innovative companies to have their products used by big health systems is the IT organization. They don’t have the time and resources to complete the interfaces, or there’s a lack of understanding around anything from security standards to interoperability.

Big platform companies like Infor and the large clinical software vendors should think about how we can facilitate the inclusion of that other cool technology that can help drive value. How can we more easily connect them into that ecosystem for the purpose of creating balance? That should be one of the central themes that we as big platform vendors should be thinking about. I think a lot about that in my role at Infor.

How do you assess the federal government’s interest in interoperability?

The Cures Act has laid down to the letter the requirement to interoperate. Vendors often give lip service to how they’re adhering to that, and some vendors continue to push back. We are seeing an absolute requirement to go do that. We’re looking to facilitate it.

What we need is an attitude change. While it can legitimately be an impediment to competitiveness, what we should be thinking about is how we’re working together to advance an industry right now that is not in the best of shape, an industry that is critical to us as a society. We need to take that signal, act on it, and find ways to include others. We are seeing those signals from life sciences, big lab testing companies, and payers that they need to be a part of that as well. They are developing standards that are oriented towards meeting those federal guidelines and making data liquidity a prime imperative in healthcare.

What was your reaction when you saw that the information that is needed for pandemic-related public health reporting was being sent by fax machines and emailed worksheets?

It’s just such an incredibly inefficient process. There is regulation to begin phasing out fax machines, but we need to move more quickly. That’s an area that we think will evolve quickly, even potentially with stimulus, in the area of supply chain and public health reporting. Those are necessary when something goes wrong, such as a once-in-a-generation pandemic.

The billions and billions that we’ve spent were sufficient in areas such as telehealth, but didn’t get us where we needed to be in terms of a fractured and disrupted supply chain and using antiquated technology to quickly report on outcomes. Interoperability becomes a central theme, and while we have had so many attempts with CHINs, RHIOs, and the rest of the alphabet soup, we still haven’t effectively created a true system-wide capability to normalize data and move that data around for those purposes that you’re describing. That’s critical as we move forward.

Are customers asking for new capabilities or guidance to help them stabilize their supply chains?

We asked clients what they need most. We responded quickly by developing supply chain dashboards for PPE. We are proud of how we were able to participate in a bit of a solution. We think that will be an ongoing need, the requirement to connect disparate supply chains and to develop functionality to find clinically equivalent alternatives when a particular supply, device, or PPE item becomes unavailable. We have to evolve with our use of AI, machine learning, and physically connecting suppliers. We will work closely with our customers as we go forward because it will be critical if we experience something like COVID-19 again.

What product opportunities do you see with AI?

For us, again as a platform company, we have so many opportunities to advance and help. It’s really listening to the market. What we are hearing from caregivers and business operations associates is that supply chain becomes a huge issue. We saw human capital management evolve and the role of chief human resources officer created around the country, and we expect to see more senior executive supply chain personnel taking roles in the strategy of the organization.

We also see a huge need around real-time location services in contact tracing, to be able to efficiently understand where a diagnosed patient has been, what equipment they have touched, and where that equipment is at the moment. Apple and big tech companies are working on that for consumer. We have solutions, but more importantly, we need to continue to evolve that inside of the hospital system. It’s critical when you have something like COVID-19 or Ebola that you know where things are, whether they are usable, and who is coming in contact with them.

The pandemic seems to be accelerating the health system acquisitions that create sprawling regional or even national enterprises. How do you respond as your customers get bigger and move into business areas that don’t involve traditional hospital operations?

You respond by listening, even though that is a bit of an obvious answer. We also try to educate ourselves to become healthcare experts. We spend a lot of time talking to outside interests, outside experts, and trying to understand where we should push, advance, and lead through thoughts and action.

We saw two things advance during the pandemic. We saw not only telehealth and the inevitability of pushing healthcare out more directly into the community, but we also saw an evolved need for inpatient facilities. We had been moving away from that over the last decade as we attempted to decentralize healthcare, but all of a sudden, we saw this need to ramp up quickly.

As a software vendor, the key is flexibility. Are we making core investments in the things that we do well today? Are we making core investments in technologies that allow us to be flexible, like contact tracing and interoperability, things that allow us to move where healthcare is and to bring our solutions and services where our customers need them, not where we think we’ve designed them to operate? That’s a critical piece.

Do you have any final thoughts?

We hope that investors and users will give us the opportunity to display how a traditional ERP company can become central to a mission. It’s not enough to upgrade technology, create a better user look and feel, and deliver greater functionality in its traditional sense. We can be accretive to the broader picture of healthcare by providing this healthcare operations platform that helps balance out that ecosystem, works together with clinical, and advances the overall mission of the organization. That’s what Infor is looking to do, and we invite others to speak with us and give us that chance.

Morning Headlines 6/29/20

June 28, 2020 Headlines No Comments

Risky Assets and Traffic Still Prevalent in Leading Healthcare Orgs

Cybersecurity firm Expanse finds exposed Remote Desktop Protocol servers and potential exposure to state-sponsored attacks, among other security weaknesses, after monitoring the Internet traffic of six unnamed Fortune 500 healthcare companies.

Microsoft to close physical stores, take $450 mln hit

The COVID-19 pandemic accelerates Microsoft’s plans to close all of its retail stores.

Oscar’s health insurance platform nabs another $225 million

Tech-heavy, direct-to-consumer insurance startup Oscar raises $225 million, prompting analysts to speculate it may be considering an IPO.

Monday Morning Update 6/29/20

June 28, 2020 News 5 Comments

Top News

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Cybersecurity firm Expanse finds from monitoring the Internet traffic of six unnamed Fortune 500 healthcare companies that:

  • Half are getting traffic from exposed Remote Desktop Protocol servers, which allows brute force password guessing.
  • One-third are receiving Internet accesses from the deprecated Server Message Block v1 that is used for printer and port access, a popular way to spread major attacks such as Petya and Wannacry.
  • One-third showed regular traffic from servers and devices in Iran, opening them to the possibility of state-sponsored attacks in the absence of geographic traffic filtering.
  • Every company had outbound Tor traffic originating from its network, indicating that their security policies do not prohibit it.

Some of the RDP servers had brute-force password-guessing attacks underway and did not have Network Level Authentication enabled.

The SMB traffic indicates that those companies were already the victim of data exfiltration.


HIStalk Announcements and Requests

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Three-fourths of poll respondents who have had a recent telehealth encounter provided their pre-visit information via an electronic form or upon being asked by someone other than the provider. Some gave their information directly to the clinician, while 12% either weren’t asked about allergies, meds, history, etc. or had to volunteer it.

New poll to your right or here: When will healthcare conference attendance rise to 75% of pre-COVID levels? Your answer will need to incorporate your predictions of the underlying factors, such as availability of an effective COVID-19 vaccine, healthcare business conditions, attending conferences versus alternatives, etc.

I was thinking about the challenge of getting people to wear masks despite their indifference, ignorance, or pathetic choice of ways to protest whatever it is that they’re angry about. My idea – hire marketing people to mount multiple targeted campaigns like the successful “Don’t Mess with Texas” anti-littering one from years ago. We know now that the pandemic isn’t going away soon, so we have time to convene focus groups and think of creative ways to encourage people to put them on given that rational thought isn’t doing it. I suggest distributing free masks that bear the same kind of lowbrow messages that people are willing to deface their cars to display publicly — think stick figure families, cartoons of a Ford truck owner peeing on a Chevy, 13.1 and 26.2 ones (ironically placed on vehicles), or those oval ones with made-up airport codes touting town pride. We know that marketing and social media advertising change behavior in ways that science and empathy won’t.


Webinars

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


Acquisitions, Funding, Business, and Stock

Microsoft will close all of its physical stores.


People

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Predictive EHR workflow vendor Wellsheet hires Frederik Lindberg, MD, PhD (Friend Health) as VP of product management.


Announcements and Implementations

Redox publishes a podcast that describes its recent layoff of 44 employees and how it made the decisions that were required, making the process transparent in hoping to help other companies that are navigating their recovery from the pandemic.


Government and Politics

The White House asks the Supreme Court to overturn the Affordable Care Act, which would eliminate health coverage for 23 million Americans.


COVID-19

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Case counts spiked in 36 states over the weekend, with Florida’s nearly 10,000 new cases on Saturday rivalling New York’s worst historic levels. More than 40,000 new cases were reported nationally on Friday as the CDC reports that actual numbers are likely six to 24 times higher. The US death count is at 127,000 as experts question whether the economic pain that was inflicted during the months-long but effective national shutdown was worth it now that complacence has raised the “flatten the curve” imperative once again.

Texas Medical Center stops publishing its base and surge ICU numbers, right after Houston area hospitals walked back their “our ICUs are about to be overwhelmed” message just 18 hours later in saying that they have plenty of capacity and their earlier dire warnings were overly alarming. This came days after the governor ordered hospitals in four Texas counties to stop performing profitable elective surgeries. Some Harris County hospitals are ignoring the governor’s order and the Texas Hospital Association says individual hospitals should be able to decide for themselves whether to perform elective procedures. The state has 5,500 patients hospitalized with COVID-19, extending its 16-day string of ever-increasing inpatient counts. TMC just announced that it will bring back the missing information in a form that better explains the capacity situation.

Texas reports hours-long lines for COVID-19 testing, along with limited capacity due to a shortage of supplies and crashing of websites for testing sign-up.

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In Australia, the government’s $2 million COVID-19 contact tracing app has been downloaded 6 million times, but has yet to identify any contacts that hadn’t already been found via manual tracing. The app seems to have problem when the IPhone of the user or their contact is locked. Problems have also been noted with IPhones and Android phones sharing information. Of 926 new cases, only 40 people had the app installed and allowed health officials to look at the contacts it had flagged.

Former FDA Commissioner Scott Gottlieb, MD predicts that schools won’t open in the South in the fall due to the overwhelming infection spread. He also notes that the US was doing a poor job of contact tracing even before the daily new infection count hit 40,000, where such activity becomes basically impossible anyway.

A New York Times report says that college towns will be hit hard economically from COVID-19 due to reduced on-campus living, cancelled sporting events, and closed bars, calling out specifically campuses in rural areas such as those of Cornell, Amherst, and Penn State.

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Arizona — which still hasn’t closed bars, mandated the wearing of masks, or prohibited large indoor political rallies without masks — publishes a point system to decide who gets ICU resources versus those who will be left to die without them. Arizona has 2,700 patients hospitalized with known or suspected COVID-19 (triple the number from a month ago) and nearly 500 are on ventilators (double the month-ago count). Nearly 90% of adult ICU beds are occupied. Imagine how bad it would be if the mostly elderly snowbirds in Arizona and Florida weren’t gone for cooler weather elsewhere.

New York State reported just five COVID-19 deaths on Saturday versus its previous peaks of around 800. The state mandates a 14-day quarantine for visitors from high-infection states.

Harvard’s Ashish Jha, MD, MPH raises the interesting point that while young patients have lower COVID-19 mortality rates than older ones, it is true of every disease that younger people have better survival odds. He looks at it differently: a 40-year-old patient who is admitted for COVID-19 has the same mortality rate as a 70-year-old who has a heart attack. Coronavirus still kills 5% of hospitalized patients aged 35-44 and Florida’s numbers are skewing much worse.

Members of the Congressional Hispanic Caucus demand that HHS explain its HHS Protect COVID-19 data project, for which it issued a $25 million contract with Palantir, whose data products are used by ICE to find and arrest immigrants. HHS says the HHS Protect information is de-identified. The CIA is an investor in the company.

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UCSF’s Bob Wachter, MD summarizes the present state nicely.


Sponsor Updates

  • PMD VP of Business Development Ted Ranney, MBA publishes a Medical Economics article titled “Telehealth best practices: Building a long-term workflow.”
  • Nuance announces that its AI Marketplace for Diagnostic Imaging is accelerating AI adoption for radiologists at leading healthcare systems.
  • OmniSys and RedSail Technology announce a strategic partnership to bring innovative clinical and revenue cycle solutions to independent and long-term care pharmacy markets.
  • IDC recognizes Pure Storage as a top five vendor in the OEM storage space.
  • Redox releases a new podcast, “Layoffs.”
  • Saykara launches a YouTube channel.
  • Summit Healthcare publishes a new case study, “Surgery Partners: Improving Processes with RPA Across all Meditech Platforms; Magic, 5.x, 6.x, and Expanse.”
  • Researchers publish “Factors Associated with Prescribing Oral Disease Modifying Agents in Multiple Sclerosis: A Real-World Analysis of Electronic Medical Records” based on data from TriNetX’s network.

Blog Posts


Contacts

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

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Weekender 6/26/20

June 26, 2020 Weekender No Comments

weekender


Weekly News Recap

  • Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions.
  • Public health officials in Austin, TX blame COVID-19 case counts that vary wildly by day on labs that are sending test results by fax.
  • The American Hospital Association loses its bid to stop the federal government from requiring hospitals and insurers to publish their negotiated prices, but will appeal.
  • Massachusetts eHealth Collaborative shuts down after 15 years.
  • CMS begins publishing a monthly Medicare COVID-19 Data Snapshot.
  • CMS announces the creation of CMS’s Office of Burden Reduction and Health Informatics.
  • Russian President Vladimir Putin calls for the healthcare system there to roll out out digital systems and to use artificial intelligence.

Best Reader Comments

While in theory I like the idea of requiring hospitals and insurers to publish their prices, I’m somewhat skeptical of the actual benefit this may provide to patients. To the majority of patients in this country who are insured by a commercial payor or CMS, unless the anticipated out of pocket costs are also provided, I suspect the published price itself will be ineffective in driving patients to lower cost alternatives … with health system monopolies and the ubiquity of employer-provided health insurance, patients simply don’t have much of a choice either where they get their care or who their insurance provider is, which will only cause prices to continue to rise. (Dr. Gonzo)

Administrator Verma’s heart seems to be in the right place and the tweets carry a lot of bite. But I am skeptical that asking current health systems players to take on the role of addressing social and economic factors of their patients is going to work. Those who know the system know very well that American health system has had its knee on the neck of racial minorities and economically disadvantaged for a long time. You don’t get to be a part of $4,000,000,000,000 annual industry without shattering a few million middle class dreams. (SeismicShift)

I would question how many companies are as worried now about how to “strategically reallocate those unused marketing dollars” but rather how to use those funds to meet a demanding payroll and to stay afloat until the markets are open and the economy levels out. (Just Wondering)

Healthcare is but one symptom of a system ripe for correction. What can we say about the richest nation in world history with currently 48 million of us lacking nutritious food on a regular basis, including 16.2 million children? USA needs to look long and hard at its fantasy that we all are existing on a level field. (Kevin Hepler)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Mr. H in Georgia, who asked for a robotic center for his school’s media center. He reported in February, “Thank you for your generous donation. It has truly exposed boys and girls in a variety of grade levels to how coding can be a fun learning experience. We have built the robots, practiced building block languages, and have even implemented different movements with the Kamigami Robots. An activity the students always look forward to in the program is playing tag with the robots. Each student has to use the coding language to try and disable the other robot in a specific time session. I am working to continue to create authentic and innovative activities that will promote their knowledge of computer science. The smiles on the students’ faces would not have been possible without your support.”

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Dermatologist and YouTube star “Dr. Pimple Popper” Sandra Lee, MD unsuccessfully tries to hide her social media tracks after insulting nurses everywhere.

In Russia, a nurse whose hospital employer reprimanded her for showing up for work in a see-through PPE gown with a sports bra and short underneath because she was getting overheated lands a modeling contract.

Columbia University ED doctors describe how to tame your email inbox using crisis resource management techniques:

  • Have one person summarize multiple status reports into a single email that is sent at the same time each day and with the same subject, format, and section headings.
  • Include the titles of everybody who is sent a group email or is added to thread.
  • If a recipient is being included just as an FYI for one message in a thread, use BCC so they don’t get future group messages.
  • Don’t just make broad requests for help – assign tasks to specific individuals with timelines and expectations on reporting back. Otherwise “email is commonly abused as a tool for putting work on somebody else’s desk without having to confirm that they can take it on.”
  • Add action requests to the subject line in brackets “[respond EOD].”
  • Ask why you are being added to an existing email chain and what expectations are involved.
  • Use the SBAR concept (situation, background, assessment, recommendation) to make communications concise.
  • Encourage people to speak frankly.

The former CEO of Union General Hospital (GA) and one of its doctors are sentenced to federal prison for their roles in scheme in which the doctor prescribed the CEO 15,000 doses of opioids in return for being paid for additional hospital work and being placed on its board.

A Colorado anesthesiologist gives up his medical license and serves 30 days in jail after turning off all the patient monitors in a hospital’s recovery room with a rant about how the noise creates alarm fatigue for nurses, then choking a nurse who told him to leave the machines alone.


In Case You Missed It


Get Involved


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Morning Headlines 6/26/20

June 25, 2020 Headlines No Comments

Kaufman Hall Software Becomes Syntellis Performance Solutions

Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions, with investment from private equity firms Thoma Bravo and Madison Dearborn Partners.

Cedar Gate Technologies Acquires Citra Health Solutions

Analytics-focused, value-based care management vendor Cedar Gate Technologies acquires Citra Health Solutions and its EZ-Suite claims, benefits, and care management software.

Leidos receives $170M task to provide MHS GENESIS Stage 6 Enterprise Services

The DoD gives Leidos a $170 million task order for MHS Genesis services that will include program management, enterprise sustainment, license maintenance, and operational management services.

Mayo Clinic launches advanced care at home model of care

Mayo Clinic (MN) launches a home healthcare service using technology from Medically Home under its new Mayo Clinic Platform, an initiative that aims to create new ventures using the latest technologies.

News 6/26/20

June 25, 2020 News 3 Comments

Top News

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Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions, with investment from private equity firms Thoma Bravo and Madison Dearborn Partners.

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Kaufman Hall’s Kermit Randa will move to the new company as CEO.

The business was created from Kaufman Hall’s Axiom Software and its recently acquired Connected Analytics practice of Change Healthcare.


Reader Comments

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From Barely Covered Enmity: “Re: Shafiq Rab leaving Rush University Medical Center. Interesting that his LinkedIn says he is a senior advisor to Michael Dandorph, the CEO of Wellforce. Bill Shickolovich is still listed as CIO, but Dandorph came from Rush. Wellforce is a relatively new player in MA, with Tufts Medical Center primarily on Siemens, Lowell General on Cerner, and Melrose-Wakefield on Meditech. Most affiliated providers are on eCW. They have announced plans to move all to Epic.”

From Generally Specific, MD: “Re: telemedicine EHR entries. Our billers tell us that we have to record three numeric entries in the vital sign section of our EHR to quality for telemedicine payment. You’re allowed to take the patient’s word on height and weight (yup). Some people will give you a temp, home blood pressure check, or data from Apple Watch or Fitbit. When all else fails, I see if they can feel a pulse (big one in neck if wrist fails) and have them count while I time 15 seconds on my phone. Or watch them breathe. If someone doesn’t look good, I have to get them seen in person anyway.”

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From Swag Seeker: “Re: conferences. Will HLTH cancel?” They already have. HLTH announced last week that the October event will be virtual (meaning: a flop.) HLTH has held just two conferences in its short existence, the first in May 2018. I would not want to be HIMSS, RSNA, or other non-profits that fill the bank mostly from their member conferences, but HLTH is even worse off in being funded by VCs and having no other line of business to fall back on. HLTH made some puzzling decisions about locations and dates early on but managed to lure a lot of healthcare luminaries and their expense accounted-fueled groupies to generally positive reception. They will now try again in Boston in October 2021, assuming that (a) they survive, and (b) that anyone cares by then. Conferences aren’t coming back strong until a year or two after a vaccine is proven to be effective, if ever, and we may have found better ways to spend the time and money of our employers by then.


HIStalk Announcements and Requests

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I’m watching and recommending  the Netflix medical documentary series “Lenox Hill,” which follows four doctors and their patients at Northwell Health’s Lenox Hill Hospital. Fun fact: Northwell pays featured neurosurgeons David Langer, MD (above) and John Boockvar, MD more than $2 million each per year. Google-stalking suggests that Langer’s summer house in the Hamptons, site of the retreat the doctors attended, is worth a cool $3 million. Still, they seem like highly competent, mostly nice guys, although I bet that being surgeons that some critical, loudly recited monologues to eyes-downcast co-workers were left on the virtual cutting room floor.


Webinars

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


Acquisitions, Funding, Business, and Stock

The Massachusetts EHealth Collaborative will sell its remaining assets and shut down operations. The non-profit sold its technology assets and customer accounts to population health management and analytics vendor Arcadia last month. The majority of its employees, including President and CEO Micky Tripathi, have joined Arcadia.


Sales

  • Idaho will integrate its PDMP data into statewide EHR and pharmacy systems using Appriss Health’s PMP Gateway solution.
  • Teleradiology company Rapid Radiology selects OpenText’s EMR-Link software to ensure smoother transfer of imaging results to providers at long term care and skilled nursing facilities.
  • The University of Illinois Hospital and Health Sciences System will implement PhysIQ’s PinpointIQ remote patient monitoring technology to monitor employees for signs of COVID-19, and high-risk COVID-19 patients for signs of deterioration.
  • Wexford PHO goes live on the all-payer population health management solution of SPH Analytics.
  • Fairfield Medical Center (OH) chooses Updox for patient flow management, in-office productivity, and virtual care.
  • The DoD gives Leidos a $170 million task order for MHS Genesis services that will include program management, enterprise sustainment, license maintenance, and operational management services.
  • Texas Health Aetna will use the SMS/IVR technology of CareSignal for remotely monitoring patients with diabetes, hypertension, and asthma.

People

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Cambridge Health Alliance names Hannah Galvin, MD (Beth Israel Lahey Health) as CMIO.

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Shannon Werb (Virtual Radiologic) joins DispatchHealth as COO.

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The HCI Group names Will Conaway (Prime Healthcare) VP of provider delivery.


Announcements and Implementations

The Froedtert & the Medical College of Wisconsin rolls out a remote patient monitoring program for pregnant patients using technology from Babyscripts made available through digital health prescription vendor Xealth, which includes the health system among its investors.

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PatientPing launches an e-notification service for patient admissions, discharges, and transfers that ensures providers are compliant with the Condition of Participation laid out in the final Interoperability and Patient Access rule from CMS.

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Nordic develops an evaluation and management transition service to help health systems comply with CMS’s E/M updates, set to take effect January 1.

UCI Health (CA) adds Everbridge’s MediNav wayfinding technology to its My UCI Health app.

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MuleSoft announces GA of Accelerator for Healthcare, a set of prebuilt APIs, integration templates, and best practices that can help developers more easily integrate data from different EHRs into healthcare projects. Salesforce acquired the company in 2018 for $6.5 billion.

Mayo Clinic (MN) launches a home healthcare service using technology from Medically Home. The service falls under the health system’s relatively new Mayo Clinic Platform, an initiative led by John Halamka, MD that aims to create new ventures using the latest technologies.

Healthcare voice AI vendor Suki launches a new voice service that it says will deliver faster, more accurate company responses from normal physician speech. Its digital clinical assistant has also been enhanced with ICD-10 coding, Epic integration, and delivery of an app for Android smartphone users.


COVID-19

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Texas Governor Greg Abbott bans elective surgeries in Bexar, Dallas, Harris, and Travis counties to free up bed space for the state’s rapidly expanding epidemic. Texas Medical Center says it will need to tap surge capacity this week and is on track to exceed total capacity within two weeks. The governor will also halt further reopening phases, acknowledging the state’s “massive outbreak” after it rushed to reopen despite increasing numbers. Abbott said two weeks ago that there was no reason to worry about reopening because “we have so many hospital beds available to anybody who gets ill.” Texas allows churches, governments, daycare centers, and camps to operate without occupancy limits, while bars, sporting events, swimming pools, libraries, and amusement parks can operate at 50% occupancy. Restaurants are limited to 75% capacity. Abbott, who previously refused to require mask-wearing and barred local officials from implementing their own mask requirements, encouraged Texans to wear masks in announcing his executive order Thursday. Perhaps it bears repeating that being discharged alive from a COVID-19 hospital stay doesn’t preclude a shortened lifetime of suffering, never-ending medical interventions, and hugely diminished quality of life. The ability to get an ICU bed and ventilator should not provide a false sense of security.

Public health officials in Austin, TX blame COVID-19 case counts that vary wildly by day on labs that are sending test results by fax, requiring their employees to re-enter the information manually. County officials want to know which labs are involved for possible enforcement of the state law that requires digital reporting.

COVID-overwhelmed Arizona is experiencing the same problems that other states ran into early in the pandemic — long lines for testing, a shortage of testing capacity, and a lack of coordination among hospitals and doctors offices to match testing demand to availability.

West Virginia Governor Jim Justice fires Cathy Slemp, MD, MPH, commissioner of the state’s Bureau of Public Health, claiming that her office unintentionally inflated COVID-19 case counts by failing to exclude recovered patients.

CVS Health announces GA of Return Ready, a customizable COVID-19 screening, testing, and analytics program for employers and universities that also offers digital tools for symptom monitoring and contact tracing.

Bars are increasingly looking like a COVID-19 breeding ground in states where they are open, with factors being close quarters, fearless young customers who don’t wear masks, proprietors who flout distancing and crowd size mandates, and loud conversations that spray more droplets. Patrons who don’t know they’ve been infected are spreading the infection to people who are more cautious.

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COVID-19 is forcing health system to change their plans for developing hotels to house elective surgery patients and visitors, many of them cash-paying residents of other countries. Miami’s $500 million, 680-foot tall Legacy Hotel and Residence will feature a 256-room hotel, a 100,000 square foot medical center, condos, bars, restaurants and shops, but its CEO says he doesn’t use the term “hospital” for reasons that go beyond the legal one of not offering emergency services — “You’re in a luxury hotel. You don’t want to be around people who are dying.”


Other

The American Hospital Association loses its bid to stop the federal government from requiring hospitals and insurers to publish their negotiated prices. AHA had argued that the White House did not have the legal authority to require such disclosure, that compliance would create overwhelming administrative burdens, and that such transparency might increase prices. The federal judge disagreed, ruling that informed customers should drive prices down and that hospitals attack transparency measures in general to keep patients in the dark about pricing. Hospitals are appealing the ruling.

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A review of the VA’s HIT-related outpatient diagnostic delays over several years finds five key high-risk areas: overwhelming EHR inbox notifications and communications and lack of coverage for absences; lack of interoperability and visible surfacing of important information; technical problems; data entry issues; and systems that don’t track test results. It cites previous studies in which PCPs reported missing abnormal test results because of an overloaded EHR inbox that requires more than an hour per day to work through. Specific cases were interesting:

  • Physicians who were notified by note to correct an EHR entry sometimes signed off without actually making the correction.
  • One clinician missed an abnormal test result that was among the 200 inbox notifications they received in one day.
  • Results were sent to clinicians who were on leave or who had left the organization with no one assigned to cover their inbox.
  • Use of note templates sometimes caused the recipient to miss important information.
  • Clinicians missed information due to delays in obtaining records, missing fax reports, delays in outside organizations posting diagnostic information to record-sharing portals, and failure to notify the clinician to review records that had been scanned.
  • Clinicians sometimes failed to review abnormal test results in subsequent encounters.
  • One clinician had customized the EHR to display only abnormal results, but missed one abnormal result because an abnormal cutoff value had not been defined.
  • Inactive radiology codes failed to trigger notification.
  • Abnormal result warnings were set to disappear when opened, so clinicians lost track if they were interrupted.

Sponsor Updates

  • VMblog features an interview with Goliath Technologies CMO Stacy Leidwinger.
  • Google Cloud hires Kathy Bonanno (Palo Alto Networks) as finance lead.
  • Halo Health publishes a case study, “Schedule-Driven Communication Improves Collaboration for Great River Health System.”
  • Pivot Point Consulting expands its telehealth services to offer end-to-end solutions, from strategy to platform selection to implementation.
  • Hyland CEO Bill Priemer shares his thoughts on potential challenges and the unknowns around working from home.
  • The Boston Globe features Imprivata CEO Gus Malezis in an article assessing COVID-19’s impact on office work.
  • Seeking Alpha profiles digital prescription savings and patient engagement company OptimizeRx.
  • Vocera partners with Mediaplanet to launch the “Empowering Our Healthcare Heroes & First Responders” media campaign.
  • PMD successfully completes its annual SOC 2 Type II and HIPAA security audits.

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 6/25/20

June 25, 2020 Dr. Jayne 4 Comments

This week has been absolutely crazy, with plenty of firefighting of both the informatics and clinical varieties.

A client that I did a quality project for last year is in the middle of an EHR go-live with “virtual elbow support,” but they had no physician super-users identified. Hard to believe, but there are still physicians out there who feel like they really need to learn it from a physician. For the client, figuring that out right before the go-live was a big miss. I’ve been playing WebEx Whack-a-Mole with a couple of physicians who won’t listen to the resources right in front of them and trying to convince them to get with the program. I’m always happy to help clients who are in a rough place, but it’s exhausting.

At the same time, my clinical practice has been having record-breaking days that make the “Flumageddon” season of a couple of years ago look like a cakewalk. They’re constantly pleading for people to come in on their off days, and I’ve covered a couple of times just so the physicians who are scheduled can have a break to sit down, eat, and have a minute to themselves. Still, it’s a never-ending revolving door of COVID swabbing, antibody testing, and processing of lab results as well as following up on infectious patients. Add in the usual summertime orthopedic injuries, lacerations from whacking the back of your head on a diving board while trying to execute the perfect cannonball jump, and a couple of ruptured appendixes in patients who were “afraid to go to the hospital” and it’s a recipe for disaster.

We’re leading the region with antibody (serology) testing, and I have to say I have mixed feelings about it. The visits take a tremendous amount of time, as we counsel patients to understand that having a positive antibody test isn’t the immunity passport that they thought it would be based on what they saw on Facebook. Many of the patients had respiratory infections in January or February and we have to explain that with that timeline, it’s much more likely that they had flu or bronchitis or one of the other garden-variety illness that was going on.

The rates of positive antibody results in my area are low, and although it’s good data from the public health perspective, it doesn’t do anything for the management of individual patients and it sure adds a lot of cost to the healthcare system. Since most insurers are covering it 100%, patients are eager to feel like they’re “doing something.” The American Medical Association continues to be vocal in spreading the word that antibody tests aren’t the path back to our old normal. We still know too little about what protection antibodies might provide or how long it may last, and there are risks for both false-positive and false-negative tests.

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The traditional July 1 start date for new interns and residents is less than a week away, and I don’t envy them the weirdness that they’re walking into. I was glad to read this heartwarming piece about a mother and daughter who both graduated from medical school this spring and matched together for residency. The elder Dr. Kudji had been a registered nurse and a nurse practitioner prior to entering medical school in her 40s and matched in family medicine. The younger Dr. Kudji will be pursuing a residency in general surgery.

Another piece sent by a reader tugs at the heart strings: A pediatric cardiologist in Bolivia was challenged to find a machine to create implanted devices to fix heart defects through a non-invasive procedure. He turned to the country’s indigenous women to weave the amazing devices by hand, often using a single piece of wire. It’s worth the watch just to see the devices in action as they deploy.

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Less heartwarming was the invitation I received from the American Telehealth Association for their virtual conference, a mere three days before the multi-day meeting was to start. They must be desperate for attendees because they offered a code for $350 off the regular $650 registration price. I don’t know of too many physicians who can clear their schedule with just a couple of days’ notice. InTouch Health did a must better job promoting their upcoming conference with more than a month notice. The July conference is free and features multiple tracks, including a COVID one.

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This week, CMS announced the creation of the Office of Burden Reduction and Health Informatics. It’s designed to continue the “work of reducing regulatory burden to allow providers to focus on patients instead of paperwork and reducing healthcare costs.” It appears to stem from the Patients over Paperwork Initiative (with CMS stubbornly refusing to capitalize the O, for some reason).

The CMS press release touted its successes, but as a frontline urgent care clinician, absolutely nothing has changed as a result of this ongoing work. My staffers are still collecting plenty of data elements that aren’t helpful at the point of care for the conditions I’m treating in the majority of my patients. There may have been benefits in reporting and streamlining of conflicting initiatives, but that doesn’t help us in the exam room.

CMS Administrator Seema Verma was quoted as saying the new office will “increase the use of health informatics” and I’m as eager as the next person to see what they have in store. Perhaps we could start with a nationwide unique patient identifier, since CMS says that “fostering innovation through interoperability will be an important priority.” That will also help with their goal of “new tools that allow patients to own and carry their personal health data with them seamlessly, privately, and securely throughout the healthcare system.”

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From Just Betty: “Re: BJC HealthCare. Check out this data breach notification letter from one of its flagship hospitals. The return address on the letter is for a construction company in Sacramento, CA. Do you think it’s a scam?” There’s nothing quite like following one unfortunate event with another one. In this case, some suspicious activity in employee email accounts resulted in an investigation that was “unable to determine whether the unauthorized person actually viewed any emails or attachments in the employee email accounts.” Compliance officers reviewed the contents of those email accounts and found patient information that may have been accessible, including patient name, date of birth, account number, diagnoses, medications, providers, treatments, and facility locations. It’s hard to believe people are still emailing files around that contain PHI. The return address does indeed belong to a construction company 2,000 miles away from the corporate headquarters. In addition to looking for some employee training to prevent phishing, I bet they’re also looking for a breach notification vendor.

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A reader sent me a link to a paywalled article about a “recovery area” at New York City’s Mount Sinai Beth Israel hospital. Designed for healthcare workers who need to escape, it features recliners, music, and aromatherapy to reduce stress. They’ve opened more than 10 rooms at different facilities and note a self-reported reduction in stress after only a 15-minute visit. Since this was the week I was supposed to be volunteering at a camp which is instead holding “Virtual Summer Camp,” I’m de-stressing in my yard. Today’s challenge was to build a camp gadget or campsite improvement. I’m not sure what my neighbors think of my COVID-essentials dispenser, but my fellow virtual campers enjoyed it.

What’s your favorite knot or lashing? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/25/20

June 24, 2020 Headlines No Comments

MAeHC Winds Down Operations After Over 15 Years of Helping Health Organizations Innovate Through the Use of Information Technologies

After selling certain assets and transitioning the majority of its employees to population health management company Arcadia, the Massachusetts eHealth Collaborative will sell off its remaining assets and shut down.

Somatus Raises $64 Million in Series C Financing to Transform Kidney Care

Kidney care company Somatus raises $64 million in a Series C funding round, bringing its total raised to $105 million.

FDA Announces First of Its Kind Pilot Program to Communicate Patient Reported Outcomes from Cancer Clinical Trials

The FDA launches Project Patient Voice, a website that offers cancer patient-reported data about symptoms experienced during clinical trials.

Morning Headlines 6/24/20

June 23, 2020 Headlines 1 Comment

Trump Administration Issues Call to Action Based on New Data Detailing COVID-19 Impacts on Medicare Beneficiaries

CMS Administrator Seema Verma says that analysis of Medicare claims confirms that socioeconomic status, race, and ethnicity of COVID-19 patients affect their likelihood of complications.

Cerner’s ‘transformation’ work continues with more layoffs in KC, across the country

Cerner conducts another round of layoffs, this time involving 100 employees.

DispatchHealth Raises $135.8 Million in Series C Financing

High-acuity house call provider DispatchHealth raises $136 million in a Series C funding round, increasing its total to $217 million.

CMS Unveils Major Organizational Change to Reduce Provider and Clinician Burden and Improve Patient Outcomes

CMS creates the Office of Burden Reduction and Health Informatics, which will look at the burden of meeting CMS compliance requirements, fostering innovation through interoperability, and using technology to create new patient-friendly, data-sharing tools.

News 6/24/20

June 23, 2020 News 1 Comment

Top News

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CMS Administrator Seema Verma says that analysis of Medicare claims confirms that socioeconomic status, race, and ethnicity of COVID-19 patients affect their likelihood of complications.

Verma says the US health system needs to transition from fee-for-service to value-based care and to hold providers accountable for outcomes.

CMS has started publishing a monthly Medicare COVID-19 Data Snapshot. The initial release indicates that 325,000 Medicare beneficiaries were diagnosed with COVID-19 through May 16, with 110,000 of them being hospitalized. Blacks were hospitalized at a rate four times that of whites.

CMS also announces the creation of CMS’s Office of Burden Reduction and Health Informatics, which will look at the burden of meeting CMS compliance requirements, fostering innovation through interoperability, and using technology to create new tools to allow patients to own and carry their health data and to give clinicians their complete medical history.


Reader Comments

From Wilson’s Gremlin: “Re: telehealth visits. I’m wondering what percentage have deficient pre-screenings performed (temperature, blood pressure) because appointments are remote? Or that require patients to leave home afterward for follow-up (for blood to be drawn or for a nasal swab)?” Good question – maybe someone knows. That would lead me to wonder whether traditional practices had to reconfigure their EHR to make in-person measurements such as temperature optional rather than required. It would also be interesting to know how many physical trips a virtual visit generates (lab, pharmacy, X-ray, PCP, etc.) although most of those would have been required even with a face-to-face visit.


HIStalk Announcements and Requests

Newbie vendor prospecting and marketing people are working energetically from home with minimal supervision and mentorship, so I’ll provide these tips:

  • Do not “circle back” if a health IT executive didn’t find your first unsolicited email interesting enough to respond the first time.
  • Do not hound people on LinkedIn with unsolicited connections and boilerplate messages.
  • Do not send unsolicited calendar appointments.
  • Whatever your company sells may well be the most important part of your universe, but the provider world is dealing with decimated revenue and COVID-19 challenges, so you aren’t anyone’s top priority.
  • Those books on lead generation, sales funnels, and social media marketing that you ordered from Amazon push ideas that are not only ineffective in selling to the health system C-suite, but often detrimental.
  • Focus on their problems, not your needs.
  • It is risky for an industry newbie to pursue a conversation with someone who has decades of health IT leadership. Your unfamiliarity with the industry’s lingo, lack of broad knowledge, and insecurity-driven adherence to the company-approved conversational script makes success unlikely even if you get someone on the phone.

Webinars

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


Acquisitions, Funding, Business, and Stock

Cerner conducts another round of layoffs, this time involving 100 employees. The nails-on-blackboard corporate phrase “new operating model” was uttered yet again as an explanation.

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CoverMyMeds finds in a comprehensive prescription access report that 70% of patients have made sacrifices to obtain their medications, while 30% of providers say their patients are unable to pay for meds. COVID-19 has caused changes – 20% of patients paid cash for prescriptions; two-thirds say they are more likely to use telehealth going forward; 30% of providers say their biggest telehealth challenges are privacy concerns and lack of EHR integration; and 80% of providers say their telemedicine use is hampered by patients who lack technology skills. Patients who are prescribed specialty medications report delays of up to several weeks waiting for prior authorization. Most prescribers don’t trust the formulary and insurance benefit information contained in their EHRs and 86% of them say their office bears a “high” or “extremely high” workload burden in managing prior authorization requests.

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High-acuity house call provider DispatchHealth raises $136 million in a Series C funding round, increasing its total to $217 million. It offers home visits that can include lab work, EKG, infectious disease tests, medications, IV placement, breathing treatments, suturing, catheter placement, and splinting.  The company operates in 19 cities and accepts many insurances, leaving patients an out-of-pocket cost that averages $5 to $44.


Sales

  • Billings Clinic (MT) will implement TransformativeMed’s specialty- and disease-specific EHR workflows, which include notification, messaging, and a COVID-19 app. The company will also be developing a nursing handoff app.

People

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Physician practice change analytics vendor Empiric Health hires Spiro Papadopoulos (Stanson Health) as VP of business development.

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Shally Pannikode (WellStar Health System) joins Humana as CVP/CIO of healthcare services.

Rush University Medical Center SVP/CIO Shafiq Rab has resigned, according to his LinkedIn.


Announcements and Implementations

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AbleTo launches population-based virtual mental health services to payers.

PatientKeeper develops its Charge Capture software into a FHIR-based app that is embedded in Cerner, allowing clinicians to launch the charge entry screen within their Cerner workflow to record patient charges.


COVID-19

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US COVID-19 infection doubling time has dropped from 60 days last week to 52 days now, with 31 states reporting an expanding epidemic. Deaths are at their lowest levels in three months, however, leading to interesting speculation as to why. Most likely answer – younger people are getting increasingly infected without becoming seriously ill, but the infection’s spread to more vulnerable populations in the absence of mitigation strategies is inevitable. Most optimistic but unlikely answer – treatments and care management are improving outcomes.

Coronavirus seems to be infecting people under 50 at higher rates than were observed in the Northeast, with 50% of hospitalized patients and 30% of those in ICUs being under 50 in the Dallas-Fort Worth area. The median age of people who are testing positive in Florida has dropped from 65 years in March to 35 now, which may be a function of more widespread testing, but also possibly because older people are protecting themselves better. Florida hospitals are admitting more COVID-19 patients in their 20s, 30s, and 40s.

Texas Children’s Hospital starts admitting adult patients to free up Houston-area beds for the expected surge of COVID-19 patients. Houston Methodist Hospital says COVID-19 admissions have tripled since Memorial Day.

A preliminary report suggests that oral dexamethasone – which is cheap, readily available, and low in significant side effects — can reduce mortality in hospitalized COVID-19 patients, especially those who are ventilated or receiving oxygen.

The European Union is likely to add the US to its list of countries whose citizens will be barred from entering its 27 countries because of out-of-control COVID-19 spread. Travel restrictions will be loosened on July 1 for countries whose new infections in the previous 14 days meet or beat the EU’s average of 16 per 100,000 residents. The US is at 107.

A COVID-19 congressional hearing finds that President Trump hasn’t spoken to the government’s key pandemic players in several weeks, including NIAID Director Anthony Fauci, MD and FDA Commissioner Stephen Hahn, MD. CDC Director Robert Redfield, MD declined to answer when asked.


Other

A White House executive order suspends issuance of H-1B work visas through at least the rest of the year, prohibits US companies from transferring foreign executives to long-term US assignments, and blocks US entry of spouses of foreign-born workers. The federal government says the order will keep 525,000 people out of the country to protect American jobs. The H-1B employer program is for highly educated people in specialty occupations, most of them in technology, medicine, academics, and engineering.

Cerner VP of Government Services Julie Stoner says the VA’s rollout will take 10 years.


Sponsor Updates

  • Pivot Point Consulting performs a virtual Epic go-live at Carle Foundation Hospital (IL).
  • Central Logic CEO Angie Franks will describe health system telehealth use cases in a presentation this week to the virtual American Telemedicine Association Conference & Expo.
  • Health Catalyst joins the FDA’s COVID-19 Evidence Accelerator.
  • Optimum Healthcare IT and University of North Florida create an EHR apprenticeship program called Last Mile Training.
  • Capita Healthcare Decisions adds Healthwise’s evidence-based information to its Salus Universal patient engagement and relationship software.
  • The Chartis Group publishes a new white paper, “After the Surge: Five Health System Imperatives in the Age of COVID-19.”
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Critical Care Obstetrics Podcast, “DKA Made Simple.”

Blog Posts


Contacts

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

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Morning Headlines 6/23/20

June 22, 2020 Headlines No Comments

Cedar Accelerates Growth with $102M in Series C Funding Led by Andreessen Horowitz and New Innovation Partnership with Novant Health

Patient payment vendor Cedar raises $102 million and announces a contract with Novant Health in North Carolina.

Proprio Raises $23 Million in Series A Funding Led by DCVC

Augmented surgical imaging company Proprio raises $23 million in a funding round led by Data Collective.

OIG Strategic Plan: Oversight of COVID-19 Response and Recovery

The HHS Office of Inspector General publishes its oversight strategy for COVID-19 response and recovery, which includes protecting the integrity and security of IT systems and health technology.

Apple introduces new Covid-19 features: Hand washing guides and a mask-wearing emoji

Apple debuts several health-related Watch features at its virtual developers conference, including one that will help users wash their hands for the recommended amount of time using the proper technique.

HIStalk Interviews Suresh Venkatachari, CEO, Healthcare Triangle, Inc.

June 22, 2020 Interviews 2 Comments

Suresh Venkatachari is chairman and CEO of Healthcare Triangle, Inc. of Pleasanton, CA.

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Tell me about yourself and the company.

Healthcare Triangle combines two great companies, each successful but stronger together. One is rooted in proven healthcare and business methodologies, and the other is a born-in-the-cloud early adopter turn global leader. Together, we are a 360-degree solution with the know-how and innovation capacity to meet technology, data, care delivery, and business operation needs.

We offer solutions to three core healthcare customers — hospitals and health systems, health insurers, and life sciences companies. I’m proud of our commitment to support each one’s respective effort to improve health outcomes by enabling the adoption and optimal use of new technologies, data enlightenment, business agility, and response to immediate and emerging business needs and market trends.

I have 30-plus years of experience in creating and managing businesses in cloud, ecommerce, IT solutions and consulting services in healthcare, life sciences and banking. But nothing compares to the excitement of today’s healthcare innovative landscape.

How does the combination of traditional health IT consulting, such as EHR implementation and optimization, and cloud transformation and security benefit clients?

I am incredibly excited by this combination and its advantages. Our traditional consulting background helps us understand the complex challenges that are facing healthcare CIOs in the current ecosystem. Our technology expertise in cloud transformation and security in the life sciences space means we understand the power of cloud transformation in highly regulated environments.

The combination also guides our clients on a practical and achievable roadmap of digital transformation. For one hospital, for example, our work focus might be disaster recovery and backup, while simultaneously leading higher-level discussions on end-to-end managed healthcare IT services with the C-suite executives. Simply stated, we are all about alleviating a lot of headaches for the CIO with solutions for operational efficiencies and lowered costs.

What’s really thrilling is that bigger picture, the healthcare industry is on the cutting edge of realizing a monumental pivot among healthcare providers and life sciences. Significant high-tech advancements are happening in personalized healthcare at every stage of the patient’s healthcare journey. Innovative and customized solutions are reshaping delivery of better access to smarter and more effective care to everyone.

What pandemic-driven technology challenges and opportunities will health systems see in the near future?

We’ve recently highlighted key challenges with technology extensively in our “Return to Revenue” series. But underlying that, the greatest challenge will be maintaining the business agility that is needed to react quickly and deploy those technologies that have an impact on patient safety and are demanded by the patients themselves.

Our clients succeeded in meeting the COVID-19 crisis head on by rapidly adopting and adapting telehealth technology. Next, we recommend that they go to the next level by deploying virtual waiting rooms and exam rooms, in-home monitoring, and data solutions. Traditionally, these types of projects take years to plan and implement, but we’re seeing increasing need to drive change in weeks and even months. HTI is their enabler to continue to iterate quickly and set a roadmap for continuous practical innovation.

On the life sciences side, we witnessed two immediate COVID-19 related challenges. First, the need to analyze data extremely rapidly. Second, the need for rapid deployment of digital health technologies.

We have a customer, Stay Smart Care, who is the perfect example of digital health excellence. Their business purpose is to help people safely age in place in their home. Stay Smart Care offers remote patient monitoring, with real-time sensor data, dashboards, and chat functions. We built the entire digital health platform, from the digital health management application to the secure, compliant patient communication application. This technology offers amazing potential in multiple areas of telehealth.

My team has a deep knowledge of the healthcare system, cloud technology, and digital health applications,. We are advising our clients about solutions that will help them navigate and succeed in the next normal of telehealth.

How have the data sourcing and analytics needs of life sciences companies and researchers changed as they address COVID-19?

COVID-19 has dramatically fast-tracked research toward treatment and prevention. New collaborations are springing up to protect public health. Not surprisingly, researchers and life sciences companies find themselves having to obtain, analyze, and share a high volume of test results and other data rapidly and safely. The solutions we offer for cloud transformation make management and analysis of that data less challenging and allow researchers and life sciences companies to focus on what counts most, which is saving lives.

Specifically, our DataEZ solution – a data lake as a service, if you will – is used by five of the largest global pharma firms. It allows rapid analysis of clinical trial information, for example. One client went from conducting clinical trial to submitting the reports to compliance agencies in a matter of weeks. Before this, the process required several months.

Health system IT departments have quickly rolled out new technologies such as telehealth, chatbots, and remote worker support, delivering quick wins rather than the more typical implementation projects that can take years. Will this experience change how those IT departments manage projects and technology going forward? 

We did see some very quick technology implementations over the last few months. I hear health system leaders talking positively about the quick consensus-building and lean approach to implementation that it took to make that happen. It is a very agile approach to deploy a solution and iterate on improving it over time based on real-life experience impacting productivity and costs. We focus on delivering business agility whether we are supporting a cloud migration, providing data insights, or optimizing an EHR workflow, and I hope that momentum is sustained going forward.

How will cloud-based services change the job of the health system CIO over the next five years?

We’ve been saying for years that the role of the CIO is changing from functional technology leader to business strategist and transformationalist. Trends in innovation driving that change are digital health, personalized healthcare, telehealth, remote monitoring, data-driven decision support systems, and blockchain innovation. Cloud is the key that unlocks the capacity in our client CIOs.

Taking advantage of cloud technology and automation means that CIOs can focus on full-scale organizational transformation and drive business agility into their technology platforms. Instead of 30-day cycle to spin up a server, we’re talking seconds on the cloud. And that’s a cascading effect, right? Every win along the journey to the cloud allows the organization to transform faster and faster in today’s changing environment and our client CIOs to drive that change rather than constantly react to it.

What are your medium-term goals for the company?

We want to drive the conversation centered around digital transformation into a new phase of bold action. The disruption to the industry and our communities demands that we use technology to strengthen our ability to deliver healthcare despite the impact of external forces. We are flexible and practical. We will meet clients wherever they are in their digital transformation and make great advancements together accelerating the value that they see from technology.

The drive to improve care delivery and business agility in healthcare is limitless. I know that we are ready as an industry to deploy new technologies, gain enlightenment through data insights, and push toward the next frontier of digital innovation. That’s what Healthcare Triangle is here to do — to reinforce healthcare progress.

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Reader Comments

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