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June 28, 2022 News 9 Comments

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The National Academy of Medicine publishes a paper titled “The Promise of Digital Health: Then, Now, and the Future” whose authors are digital health household names that include Amy Abernethy, Patti Brennan, Atul Butte, Judy Faulkner, John Halamka, Kevin Johnson, Don Rucker, and Eric Topol. Points:

  • US health policies and health system investments are misaligned with WHO’s definition of health as incorporating physical, mental, and social well-being, not just the absence of disease.
  • Digital health has done little to improve care effectiveness, efficiency, equity, and continuity of care, as inpatient data is largely sequestered and difficult to integrate due to a lack of data standards.
  • The promise of real-time generation of evidence to fuel a learning health system exists only in a few pilot projects.
  • Potential uses of digital innovation include advancing diagnosis and treatment, ensuring care continuity, managing patients offsite via telemedicine, partnering with individuals for self-management, and reducing errors and waste.
  • Digital health measured the impact of COVID-19 by race, economic states, and underserved populations and has the potential to identify, measure, and modify the root sources of illness.
  • Social determinants of health, which cause up to 15% of premature deaths, need to be considered as in-scope by providers and health systems, as supported by the collection and integration of SDoH into EHRs and mobile apps. The risk of algorithmic bias should be considered, however, such as stigmatizing no-show patients who struggle with employment and childcare issues.
  • Digital health can also contribute to the understanding of environmental factors, such as air pollution and climate change.
  • Behavioral interventions, such as weight management programs, often don’t work, and digital programs that claim otherwise are usually not supported by evidence and weren’t produced by experts in health behavior change.
  • AI/ML as applied to genetic, genomic, and medical history data could provide near real-time feedback to individuals using a voice assistant as a “digital health coach.”
  • Architecture should focus on the individual, embed equity and transparency, and realign health system payments around outcomes and value.

Reader Comments

From Das Kapital: “Re: slow news days. I’m disappointed when there’s not much news to read in HIStalk.” That’s a feature, not a bug. Unlike most news sites, I have no incentive to pad out the good stuff with junk to draw clicks or increase time-on-page numbers. My gift to you on those slow news days is time that you can reallocate.

Meanwhile, that’s a reminder for me to offer the annual Summer Doldrums first-year, extra-months deal for new sponsors. If your company is failing to reach decision-makers; was surprised to learn that your since-departed junior marketing person ignored our renewal emails and got you cancelled; or is a small startup, Lorre can hook you up. You get a year’s worth of exposure for less than what some companies spend on Starbucks for conference booth staff.

From Oracle of Secrets: “Re: Oracle Cerner (still feels weird to write that). Larry’s reading of marketing mumbo jumbo about quality and cost improvements with the acquisition wasn’t convincing.” You should assume until proven otherwise that Oracle’s entire interest in buying Cerner is (a) to boost sales of Oracle’s existing products, especially cloud services, by getting (or making) Cerner users replace anything from Oracle’s big tech competitors Microsoft, Google, Amazon, etc.; (b) to sell more Oracle products such as ERP into the Cerner market; (c) to gain access to a supply of de-identified patient data that can be used from everything from AI training to selling on the open market; and (d) to get a bit closer to massive healthcare spending in both the US and elsewhere. Oracle may do great work in healthcare, but market precedents aren’t encouraging. It will be interesting to see how hard Oracle upsells into the Cerner client base and whether that drives clients to Epic, which by the way already offers a lot of what Larry was extolling. Readers, what is your experience with Oracle as a vendor?


HIStalk Announcements and Requests

Listening: Turnstile, Baltimore-based, high-energy punkish rockers who I found accidentally who then made a big splash at Glastonbury this week. They kind of remind me of Rage Against the Machine, but they can take an enjoyable hard turn from scrapping with throngs of on-stage mosh pit divers to playing thoughtful melodies.


I talked to a HIMSS insider about recent changes there. Notes from our chat, with the usual disclaimer that this is one non-anonymous person’s opinions and observations that have not been confirmed:

  • Some employees felt that HIMSS22 was an awkward conference, with low HIMSS employee morale and a lack of visibility of President and CEO Hal Wolf. Turnover increased immediately before and after the conference.
  • Some regional events that should have been popular have been cancelled due to lack of sponsoring vendors. HIMSS laid off around 50 people, most of them in the events area, a few weeks ago.
  • Hal’s vision was a Netflix or New York Times type subscription model for HIMSS, where people could buy a basic subscription and pay extra for add-ons.
  • Hal runs HIMSS more like a for-profit business than his predecessor Steve Lieber, with a quick, confusing switch of tactics from a non-profit and the hiring on of quite a few of Hal’s former for-profit company colleagues.
  • HIMSS wasn’t prepared for the buzz of the ViVE conference and “mouths dropped” internally upon seeing the energy it drew. HIMSS didn’t send anyone to scout ViVE, but saw recaps and photos from the brightly colored, fun conference with interesting people on stage in Miami. The industry’s aggravation level with HIMSS was high, making it the perfect time to start a competing conference. Still, HIMSS isn’t making major changes, just strategizing to increase HIMSS23 registration numbers and streamline the entry process for the “45 minute PowerPoints in windowless rooms” educational format.
  • HIMSS had previously tried something similar to HLTH and ViVE by buying Health 2.0 to get a younger and hipper crowd and to tap into investors, but “wrung the life out of it” by making it into a mini-HIMSS that suffered from “death by committee.”
  • The sale of HIMSS Analytics was “shocking” since that business had given HIMSS a way to understand health IT as an influencer rather than just a cheerleader.
  • HIMSS Accelerate was the “jump the shark” moment as HIMSS tried to push members where they wanted them instead of where those members actually wanted to be. It was supposed to change the way that HIMSS does business, but people don’t need or want another social media platform. Accelerate use is negligible outside of HIMSS employees.

Webinars

July 12 (Tuesday) 1 ET. “Digital Data Stewardship for Trusted, High-Quality Data Exchange.” Sponsor: Clinical Architecture. Presenter: Carol Graham, MS, RN, product manager, Clinical Architecture. Organizations face challenges in ensuring that the patient data they received and send is consistent, accurate, and usable. Use cases include receiving multi-source data across health information networks with variation in formats and content; merging and de-duplicating provider, payer, and research data; uplifting legacy data for current use cases and formats; and normalizing and formatting data for public health surveillance, quality measure reporting, and providing directly to the patient. This webinar will cover Pivot, a comprehensive Digital Data Steward solution that orchestrates format harmonization, content (vocabulary) normalization, de-duplication, and data quality validation into a single solution.

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


Acquisitions, Funding, Business, and Stock

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A trade court judge rules that Apple infringed on AliveCor’s atrial fibrillation detection technology, a decision that if affirmed by the International Trade Commission, could force Apple to stop selling Watch in the US or to remove the disputed technology.

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PicnicHealth raises $60 million in a Series C investment round, bringing its total funding to over $100 million. The San Francisco-based startup uses de-identified patient data culled from its PHR offering to build datasets for research.

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App-enabled at-home and point-of-care testing company Cue Health will reportedly lay off 170 employees, citing economic hardships and a shrinking market for COVID-19 testing. The company had signed testing contracts with the NBA, MLB, and HHS, among others, during the height of the pandemic.

Hartford HealthCare (CT) spins out H2O, a cloud-based predictive analytics company focused on offering providers insight into patient length of stay, and patient flow through the emergency department and during surgery. The software, developed in collaboration with MIT professor Dimitris Bertsimas, PhD, will be offered commercially by the end of the year.


People

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R1 RCM names former Cloudmed CEO Lee Rivas, MBA president. R1 finalized its acquisition of the RCM software vendor last week.

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Hackensack Meridian Health (NJ) names Sameer Sethi (Bon Secours Mercy Health) SVP and chief data and analytics officer.


Announcements and Implementations

Olive announces GA of its Autonomous Revenue Cycle, a group of solutions designed to help providers automate time-consuming, revenue-related administrative tasks.

Trinity Health of New England partners with virtual lactation platform vendor Nest Collaborative to offer virtual breastfeeding support for families who give birth at the health system’s three birthing hospitals, generally paid for by health insurance.

TriHealth says that integrating Tempus oncology genomic testing workflows with Epic helped identify available clinical trials, recommend an FDA-approved treatment, improved genetic counseling, alerted clinicians when appropriate new treatments became available for existing diagnoses, and made clinician ordering easier.

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Yale researchers develop an EHR-embedded software tool to help ED doctors initiate buprenorphine treatment for opioid abuse.


Government and Politics

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The Government Accountability Office recommends that HHS develop a way for covered entities to offer feedback on the breach reporting process. Hacking and IT incidents have increased by 843% since 2015, while unauthorized access and disclosures have increased by 43%.


Other

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An Insider investigation of virtual mental health startup Cerebral finds that the company ran itself without regard to clinical standards until the federal government intervened. The report says that the company took on patients it should not have, assigned them to clinicians — mostly nurse practitioners — and other employees who lacked training and oversight, pushed those clinicians to issue prescriptions to 95% of patients, and placed the licenses of its clinicians at risk via its policies and its disregard for state regulations. Insiders say Cerebral’s clinicians sometimes ignored the company’s requirement that they check prescription drug monitoring databases before prescribing controlled substances. Cerebral is being investigated by the DEA, DOJ, and FTC, while health insurers and pharmacies have cut ties. The company at one time had 210,000 active patients and 4,500 employees, with plans to expand to 10,000 employees by the end of this year as it planned to expand into weight loss.

A study concludes that most digital health startups have low levels of clinical robustness, as evidenced by few regulatory filings, clinical trials, and data shared publicly.


Sponsor Updates

  • Agfa HealthCare further develops enterprise imaging workflows for the Yorkshire Imaging Collaborative and South Yorkshire & Bassetlaw regions in England.
  • Everest Group’s RCM Operations Peak Matric Report names AGS Health a Star Performer and Leader for growth, innovation, and positive impact on the healthcare market.
  • Baker Tilly donates $10,000 to Camp Good Mourning as part of its Wishes grant program.
  • BDO publishes a new insight, “Minimizing Revenue Loss Due to Inpatient Status Downgrades.”
  • Clearwater hires Alka Kumar (HealthWorks) as a compliance and privacy consultant.
  • Optimum Healthcare IT hires Kenneth Martin (Elliot Hospital) as application team manager within its managed services team.
  • Divurgent names Kristal Wittman director of digital health.
  • AGS Health is again named a Leader and Star Performer in Revenue Cycle Management (RCM) Operations by Everest Group.
  • Enlace Health will present at the World Forum Bundled Payments Conference July 14 in Chicago.
  • The American Society of Nephrology has entered into a publishing agreement with Wolters Kluwer Health to publish Journal of the American Society of Nephrology, Clinical Journal of the American Society of Nephrology, and Kidney360.

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Currently there are "9 comments" on this Article:

  1. It’s amusing to see Judy listed as an author on this piece when you consider that no company has done more over the years to stop info sharing than Epic.

    • Can I get a list of all this info-blocking that Epic is supposed to have done? Generally most of the time I see that thrown around it’s usually a case where Epic obviously can share the info but hospitals don’t particularly care to enable that feature.

        • Anyone can post headlines without actually addressing the merit of the articles. Epic had valid concerns about patient privacy and misbehaving 3rd party apps, and based on recent reports that every healthcare provider and their mom is leaking PHI to Meta/Google, I would say Epic’s concerns were very well founded. You want to go ahead with opening the floodgates and allowing shady apps to have access to your data without any kind of digital privacy framework? You go right ahead. If you actually paid attention to the Interop Rule you would know that they ended up adopting many of Epic’s suggestions because they were in fact good suggestions.

        • This quote from your article is just hilariously and provably wrong.

          “At the cost of millions to billions of dollars per hospital or health system, health care relies on pre-internet proprietary and non-interoperable software where, as in the old “Roach Motel” ads, data check in, but they don’t check out.”

          Epic has a whole @$$ website at open.epic, that anyone can register for, where you can start developing against their FHIR APIs. Please explain to me how FHIR is “pre-internet proprietary and non-interoperable”.

  2. RE: NAM report.
    Funny they want to ‘digitize’ a health care system…that is by far an non-system of hodge- podge providers, with a payment system that has numerous incentives that fly in the face of improving coordination of care. And there was no mention of the failures of medical education where many of these changes need to begin. Ah yes, the easy answer is to blame the vendors!

  3. I believe that Oracle has identified it’s database business, as mature and likely declining. Oracle is facing stiff competition from Microsoft SQL Server and all those internet databases (MariaDB, PostgreSQL, there are a lot of them). DB2 and Sybase have faded are no longer serious competitors.

    Thus Oracle has Oracle Applications, which was essentially Oracle’s first foray into the applications space. Later Oracle bought a slew of tier 2 applications companies, during the Charles Phillips era.

    My guess is, this still wasn’t enough of a revenue stream, so now Oracle has entered the healthcare arena with the Cerner purchase.

    It’s an interesting move and one that both Oracle and Cerner could benefit from. However the proof will be in the pudding.

  4. You asked, “Readers, what is your experience with Oracle as a vendor?”

    Oracle is notorious for charging a LOT of money for database licenses. They also do a lot of intrusive activities like auditing user counts. Certainly other vendors do this too, but it tends to raise hackles in the customer base, regardless of what the audits find. Oracle has also been known to suddenly increase licensing costs for existing customers. This has led to many customers actively migrating away from Oracle, where they can do so.

    In general, the Oracle database is very well-regarded technically. The customers don’t complain much about software quality, features, scalability, tech support, all of that.

    Oracle Forms, which is a reporting and application development tool tightly tied to the Oracle database, is similarly respected. I’ve heard it characterized as “boring but solid”.

    On the applications side, I hear mainly good things, oddly enough. Oracle seems to be attentive to the user base, does not abandon products, issues regular upgrades, and is generally responsive and responsible. Nor do I hear complaints about the licensing costs for the applications.

    One way of explaining the negative customer experiences regarding the cost of the Oracle db system is that it is a cash cow for Oracle. The only problem with this explanation is that the Oracle db has always been expensive.

  5. There’s one more interesting story about Oracle. A few years ago, Oracle launched a version of Linux under the “Unbreakable Linux” brand.

    Well, the Free and Open Source (FOSS) community was not impressed! The Oracle corporate culture is almost diametrically opposite of FOSS culture. So while Oracle’s move was perfectly legal and allowed, I think a lot of FOSS people felt co-opted.

    However that dust-up seems to have settled. Typical Oracle customers were already used to the Oracle corporate culture, and it was helpful to run an Oracle db instance on a Linux OS that Oracle also supports.







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