Monday Morning Update 10/17/22

Top News

The VA pushes back its next Oracle Cerner go-live from January 2023 to June 2023.

VA Deputy Secretary Donald Remy says that the “assess and address” period is necessary because “the Oracle Cerner electronic health record system is not delivering for veterans or VA healthcare providers.”

VA Secretary Denis McDonough announced in July that further deployments would be delayed until January 2023 while technical and system problems were resolved. The VA was set to roll the system out to 25 VA medical centers in 2023.

The VA is sending letters to every veteran who may have been impacted by system problems at its five live sites, asking them to call the VA if they experienced delays in prescription filling, appointments, referrals, or test results.

Reader Comments

From State of Confusion: “Re: NC and Unite Us. The $14 million state SDOH referral platform procurement was funded via solicited donations from Medicaid MCOs that were paid to Foundation for Health Leadership and Innovation, which took a 10% cut off the top. State HHS appears to have chosen its vendor and terms, then asked MCOs to foot the bill instead of going through state IT procurement. Also, a competitor that bid $500K for the project was shut out via service contracts that prohibited the use of competing systems.” Unverified. Unite Us is the Goliath among mostly David-sized SDOH competitors, having raised nearly $200 million from big names such as Salesforce, Andy Slavitt’s Town Hall Ventures, and Optum, with a Series C round last year valuing the company at $1.7 billion. I know little (but suspect much) about state IT procurement, but more knowledgeable readers are welcome to chime in. Federal taxpayers gave North Carolina HHS $650 million to test and evaluate non-medical Medicaid interventions, such as those related to food and housing, in its Healthy Opportunities Pilots.

From D. L. Roth: “Re: Epic. Are they trying to dodge the FDA by changing their sepsis algorithm and definition of sepsis, or is it normal for a software company to define a clinical outcome?” I can’t see the paywalled article, but the lead paragraphs say that Epic now recommends that hospitals train the sepsis model on their own data and has changed its definition of a sepsis to a more commonly accepted standard that relies less on the existence of antibiotic orders. A just-published article in Journal of Critical Care compares nine hospitals that implemented Epic’s sepsis prediction tool to six that did not, concluding that the Epic tool didn’t improve outcomes. A JAMA-published study from 2021 concluded that “the Epic Sepsis Model poorly predicts sepsis” and generates many false alarms, questioning why so many hospitals were using it in the absence of peer-reviewed clinical validation. That’s probably the real story – not that an EHR vendor developed a clinical tool that didn’t work as planned, but that hospitals blindly started using it to support patient care without digging deeper. Still, the tool is advisory rather than prescriptive, at least when used as intended, and thus should elicit little FDA regulatory interest. The sepsis advisor may not have helped patients as much as Epic and its client hospitals had hoped, but it also didn’t hurt them. It’s a good lesson for vendors who think AI/ML is the universal hammer for all healthcare nails — Epic has 40-plus years of experience working with the best health systems in the country, so if it can mess up a clinical algorithm, imagine the clinical damage your cool startup and its team of former beer-ponging Facebook engineers could do.

HIStalk Announcements and Requests

The most valuable mid-career credential to earn is a master’s degree or vendor-specific certification, poll respondents say, although I’ll asterisk those results because they are driven by the number of respondents who actually earned one of the listed credentials.

New poll to your right or here: If your job allowed you to live anywhere, what top three factors would be most important in your choice?

Mike generously donated to Donors Choose in offering “Continued thanks to you, Mrs. H, Dr. Jayne, and all the other content contributors.” I applied matching funds to fully fund these classroom projects:

• Headphones and clocks for Ms. M’s second grade class in Phoenix, AZ.
• Force and motion exercises for Ms. D’s elementary school class on Apollo Beach, FL.
• Headphones for the third grade class of Ms. Z in Orlando, FL.
• Activities and resources for Ms. N’s first grade class in Arlington, TX.
• Math books and games for Mr. C’s middle school class in Phoenix, AZ.
• STEM robotics and Lego kits for Ms. W’s middle school class in Margate, FL.
• STEM activity kits for Mrs. S’s elementary school class in San Bernardino, CA.

I’ve heard from most of the teachers already, including Ms. N, who said, “I am so grateful; but more importantly, our students will be. Your generosity, support, and investment is so appreciated. Our students will be able to enjoy this resources for many, many years to come!”

My recovery from “The COVID” remains uneventful nearly a week in, with my only symptoms over that time being a couple of early days’ worth of mild stuffiness and a scratchy throat. I’m remaining sequestered until midweek, although CDC guidelines say I can rejoin society now as long as I wear a mask.

Great news: the cringey “reaction GIF” – painfully unoriginal video clips posted on social media by people who are unwilling or unable to use actual words — is dead, retired to the Internet boneyard by Facebook-using boomers who still believe them to be clever.

Webinars

October 18 (Tuesday) 2 ET. “Patient Payment Trends 2022: Learn All The Secrets.” Sponsor: Mend. Presenter: Matt McBride, MBA, co-founder and CEO, Mend. Many industries offer frictionless payments, but healthcare still sends paper bills to patients who are demanding modern conveniences. This webinar will review consumer sentiment on healthcare payments, recent changes to the Telephone Consumer Protection Act that create opportunities for new patient financial engagement, and new tactics to collect more payments faster from patients.

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

Acquisitions, Funding, Business, and Stock

The CEO of CVS Health says that the company will be involved in the “entire spectrum of someone’s health journey,” which includes health insurance via its Aetna business, MinuteClinic care delivery, pharmacy, and with its recent acquisition of Signify Health, the provision of in-home care. Karen Lynch also says the company will make a primary care acquisition later this year and will expand its digital offerings since otherwise “we’re never going to get that connected care and that personalized care.” She says that Amazon is a transactional company, while CVS has earned the right to be in healthcare, particularly via its COVID-19 vaccination program.

People

Lee Westerfield, MBA (Dstillery) joins Clearsense as CFO.

Announcements and Implementations

Vanderbilt and Brigham and Women’s will study the use of Synapse’s clinical decision support and medication reconciliation software to analyze drug-related risks and optimize medication appropriateness, as integrated with their Epic workflows.

Redox expands into Canada and offers API Actions, which describes specific data models as concepts that developers can more readily understand.

The National Association of ACOs asks CMS to conduct pilots of ACO submission of EHR-extracted quality of care data before mandating electronic submission. It also wants CMS to eliminate the requirement that ACOs report data on all patients from all payers, saying that ACOs that serve vulnerable patients will look work in CMS comparisons because of their sicker populations. A NAACOS survey finds that 39% of ACOs use more than 10 EHRs and only 17% use just one, forcing them to rely on third-party aggregators.

Government and Politics

An MGMA report finds that the most burdensome regulatory issue of medical practices is prior authorization, while the second is the No Surprises Act requirement that practices give good-faith estimates of out-of-network costs in advance.

Privacy and Security

In England, NHS software provider Advanced confirms that an August 4 cyberattack involved LockBit ransomware and that data was exfiltrated from Staffplan and Caresys customers. The hacker penetrated the Advanced network by using third-party credentials to establish a remote desktop session to its Staffplan Citrix server, from which it navigated the network to deploy malware. In a fascinating back story, the LockBit development team released Version 3.0 of the “ransomware as a service” that it promised would “Make Ransomware Great Again,” after which a disgruntled developer breached its systems and released the builder program on Twitter so that rival ransomware groups could use it without paying a percentage of the ransom.

Other

A Canada-based engineering society demands that “software engineers” stop using that title because they are not licensed or regulated like all other engineers.

A Minnesota health system halts plans to build a new clinic due to costs of switching its Epic host from Allina Health to OCHIN.

Bizarre: 200 decomposing bodies are found on the roof of a hospital in Pakistan, apparently placed there by its mortuary, which initially refused to allow inspectors to enter. Meanwhile, a health minister in India continues his surprise inspection of hospitals and firing those in charge for problems that include requiring families to buy patient medicines elsewhere, night nurses who don’t answer patient calls, clinicians who are absent but clocked in, and dogs running loose on the wards.

I’m honoring the memory of HIS-torian Vince Ciotti and the sunny slopes of yesterday by surfacing a LinkedIn post by Tom Sullivan on an upcoming reunion of former employees of Ray Forgit’s Medical Systems Management, which merged with Picis in 2002. Let me know of similar reunions or online groups since I’m a sucker for former health IT employer nostalgia.

Sponsor Updates

• OptimizeRx reports strong results from a recent program that used its patent-pending AI technique and real-world data to improve time to diagnosis and therapy for a complex disease.
• The Shasta County Health & Human Services Agency expands its implementation of Netsmart’s CareFabric platform to better support the California Advancing and Innovating Medi-Cal program.
• Sectra will install the radiology module of its enterprise imaging solution throughout German ANregiomed’s healthcare system.
• BCBS of Massachusetts uses Olive’s AI and automation to speed review time, automate authorizations, and eliminate administrative costs in a pilot project with New England Baptist Hospital.
• Optum releases its first Pharmacy Insights Podcast, “What’s happening in specialty pharmacy?”
• Aurora Mental Health Center reduces time to remission by 56% and increases access by 30% with Owl’s measurement-based care platform.
• Premier’s Contigo Health subsidiary completes its asset transaction for national provider contracts and licenses to cost-containment technology from TRPN Direct Pay and Devon Health.
• Redox releases a new podcast, “Patient Experience & Healthcare’s Move to the Cloud with ConvergeOne’s Matt Vestal.”
• Sectra launches its Let’s Talk Enterprise Imaging Podcast with three new episodes.
• Sphere will exhibit at Athenahealth Thrive 2022 October 24-26 in Austin.
• Surescripts releases a new There’s a Better Way: Smart Talk on Healthcare and Technology Podcast, “An Antidote to Clinician Burnout: Fusing Old-Fashioned Medicine with High Technology.”
• Talkdesk awards 2022 CX Innovator Awards to Alignment Health and Carbon Health.

Blog Posts

• Culture & Focus on Clients Fuel Growth (Pivot Point Consulting)
• Technology: A Lifeline for Burned-Out Nurses (PerfectServe)
• 8 Ways to Reduce Alarm Fatigue in Hospitals (Spok)
• Why Does Clinical Experience Matter in Healthcare IT Leadership? (Optimum Healthcare (IT)
• Call center service level and customer satisfaction (Talkdesk)
• How Healthcare Technology Can Bridge the Gap in Patient Communication (TigerConnect)
• What is a TPE Audit, and How Should You Handle It? (WebPT)

Black Book’s latest ranking of coding, transcription, CDI, and clinical information management software and services vendors include the following HIStalk sponsors:

• Comprehensive mid-RCM coding, CDI and compliance solutions – inpatient hospitals and health systems: Nuance.
• Comprehensive mid-RCM coding, CDI and compliance solutions – physician practices and ambulatory providers: Nuance.
• Clinical data interoperability solutions: Redox.
• Medical speech recognition and AI solutions: Nuance.
• EMPI and clean-up: Verato.
• Computer-assisted coding applications: Optum360.
• Vendor-neutral archive: Agfa HealthCare.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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