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Monday Morning Update 9/18/23

September 17, 2023 News 14 Comments

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Two senators ask the Department of Defense to explain how its MHS Genesis (Oracle Cerner) system has affected the time needed to get new military recruits into basic training.

The DoD says that medically clearing new recruits takes three days longer than it did before MHS Genesis went live. However, Senators Elizabeth Warren (D-MA) and Richard Blumenthal (D-CT), both of whom serve on the Senate Armed Services Committee, note that the Navy’s recruit processing time has doubled to 60 days after Genesis was implemented.

The senators say that Genesis retrieves historic patient records comprehensively, to the point that applicants are required to obtain medical waivers for old, healed injuries. A recruiter says that one enlistee had to wait an extra two months because she had sprained her wrist as a child.


HIStalk Announcements and Requests

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Doctors seeing new patients transferred their existing records into their systems electronically about one-third of time, poll respondents say, falling short of the 40% of practices that transferred nothing by any means and instead just handed patients a stack of blank forms to fill out.

New poll to your right or here: Do you know or suspect that a provider used AI in a recent encounter with you?


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HIStalk sponsors who are participating in the HLTH conference – send me your details by October 2 and I’ll include them in my conference guide.


A Reader’s Notes from AHIP’s Consumer Experience and Digital Health Conference – Day 2

  • Horizon Blue Cross Blue Shield says that virtual care went from 1% of behavior health claims before the pandemic to 60% and that high level of virtual care continues.
  • Payers won’t covered digital therapeutics just because they are FDA cleared. They want to see positive outcomes over a meaningful population size. Value-based care may be a way to cover more behavioral health interventions.
  • AI advancement may taper due to the huge amount of energy and electricity infrastructure it requires.
  • Digital therapeutics fall into two categories – cleared by FDA as a medical device, and software that powers humans. FDA’s bar seems to be set lower for the first category since randomized clinical trials aren’t required to prove that the tool works.
  • Peterson Health Technology Institute aims to be an independent assessor of digital health tools and has committed $50 million to the effort. Their assessment will include equity factors such as whether the tool reduces cost, if it is rolled out to Medicaid populations, and if it supports multiple languages.
  • Rural areas suffer from a low provider-to-patient ratio, low access to transportation, limited broadband access, and provider volumes that are too low to support fee-for-service.
  • National Coordinator Micky Tripathi, PhD, MPP says QHINs will go live in November or December, initially for provider-to-provider treatment purposes, with FHIR-based exchanged to follow in Q1.
  • Former National Coordinator Don Rucker, MD, MS, MBA expressed concerns about the approach and director of TEFCA, saying that it relies too much on old standards and data formats.
  • Two panelists would like to see prior authorization and payer-to-payer data exchange as future TEFCA use cases.
  • Even though the conference was touted as representing consumer experience, little attention was paid to how payers will fix the consumer experience issues that we all hate, such as prior authorization and understanding your policy and benefits.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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


Acquisitions, Funding, Business, and Stock

A BMJ survey finds that three-fourths of UK hospital trusts still relay on paper-based charts and patient notes, concluding that the UK government failed to meet its target of eliminated paper ordering by 2024. Most of the trusts have electronic systems, but still use paper to some degree. Experts say the NHS data set is widely admired, but is less useful than it seems because it is often stored in systems whose proprietary formats do not support interoperability.


People

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Jeff Cutler (Ada Health) joins Validic as chief commercial officer.


Announcements and Implementations

Google announces that Chromebooks that were released after 2020 will automatically receive updates for 10 years, while older devices can be set to receive those updates by the user or IT administrator. An individual device’s Auto Update Expiration date can be displayed from the Settings menu or looked up in an online list.


Government and Politics

Indiana’s attorney general Todd Rokita sues Indiana University Health, alleging that it failed to enforce privacy standards when OB-GYN Caitlin Bernard, MD talked publicly about an abortion she had performed on a 10-year-old. Rokita had previously filed an action against the doctor, who was reprimanded by the state medical licensing board for violating state and patient federal privacy laws, and was unhappy that IU Health publicly disagreed with the decision. Rokita says that IU Health failed to protect the child’s privacy, thus violating HIPAA. The doctor had previously sued the Republican AG in an attempt to prevent hum from obtaining the medical records of her patients for damaging her reputation, which the judge dismissed but with an opinion that Rokita’s public comments about the doctor on Fox News violated state attorney confidentiality laws.


Other

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Venture capitalist Bill Gurley rails against Epic in a swaggering presentation this week, which is so full of errors and unproven assumptions that I won’t bother wasting time correcting them (example: he says ONC was formed to oversee ARRA when in fact it predated it by five years; not to mention that his summary of why EClinicalWorks, Greenway, and Practice Fusion paid millions to settle federal charges is way off base.)

[Epic] is the largest player in medical or EHR software medical records. This is their CEO, Judith Faulkner. Now in 2009, Obama put her on his health IT council. She was the only corporate representative. It should not surprise you that she’s a major donor to Obama. Obama passed the American Recovery Act that was his big piece of stimulus, kind of like Biden’s inflation act that happened recently. Tucked underneath and easy to hide in this big bill is the acronym HITECH. It’s this health information technology thing. Then they created an agency called ONC that oversaw it. Now this is the part you’re not going to believe. They came up with a brilliant idea that I have to assume she helped encourage, that doctors would receive $44,000 each if they bought software, 38 billion dollars .. You may be thinking are doctors needy, but here’s the catch. This happened because of the mortgage meltdown. Doctors own multiple homes, so they have multiple mortgages, so they probably needed the assistance … ONC decided the threshold of features you would need for your software to comply with this mandate, and I’m assuming they kind of took Epic’s feature set and plowed it into this spreadsheet. They got the Department of Justice to enforce people that didn’t have the feature set that were getting the payments, and you had three record fines – $155 million, $57 million, $145 million — against the lesser competitors of Epic. Unreal. If you’ve studied “The Innovator’s Dilemma,” the way startups disrupt is they come in with lower feature products, but a feature that really matters to the customer in a simpler product. They move up they put a brick wall there so you couldn’t come up. It’s just amazing. Obama, in an interview with Ezra Klein, said this was the most disappointing part of Obamacare … You may ask, am I am I unhappy with Judith? I’m disgusted with it, but if I were a judge in the Olympic regulatory capture competition, I’m giving her a 10.

The Metropolitan Water Reclamation District of Greater Chicago finds out from a press announcement that its CIO, John Sudduth, had been hired months before as CIO of the American Board of Medical Specialties. He held both jobs as a full-time, Monday through Friday employee without his bosses finding out for 2 1/2 months because of COVID work-from-home policies.

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Not healthcare related except as an AI cautionary tale. OpenAI investor Microsoft apparently uses AI to produce crappy articles on MSN, whose content has suffered after it fired many of its human editors and started relying on wildly inconsistent syndicated articles. A now-removed article’s headline about the death of NBA player Brandon Hunter called him “useless,” strung together bizarre and incorrect details in its “story” about his career, and changed words here and there to hide its poorly executed plagiarism from other sites (it listed Hunter’s position as “ahead” instead of “forward” as originally stated in the TMZ piece it stole). The site earned unwanted attention last month after running an AI-generated travel guide to Ottawa, Canada that recommend that tourists visit the local food bank.


Sponsor Updates

  • Care.ai launches a podcast series titled “Smart from the Start,” hosted by former HIMSS CEO Steve Lieber.
  • Seashore MD streamlines patient booking and patient acquisition with EClinicalWorks EHR and Healow solutions.
  • The “HIT Like a Girl” podcast features Nuance EVP and GM of Healthcare Diana Nole.
  • Nordic releases a new “Making Rounds” podcast, “Emerging opportunities with cloud-based EHRs.”
  • Ronin will present at the virtual NLP Summit October 4.
  • Simnova in Italy will integrate Sectra’s medical education platform, the Sectra Education Portal, into their simulation training program.
  • SmartSense by Digi names Ed Marx to its healthcare advisory board.
  • Sphere publishes a new whitepaper, “Patient Payments: How Providers Can Improve the Last Mile of the Care Journey.”
  • Symplr announces that its Symplr Spend Management solution has been named number one according to Black Book’s 2023 top client-rated supply chain solutions rankings.
  • Verato will present at the Innovations in Value-based Care Conference September 27 in New York City.
  • Wolters Kluwer Health publishes “The State of Drug Diversion 2023 Report.”

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Currently there are "14 comments" on this Article:

  1. Re: Bill Gurley & Epic!
    Yes, Bill may be slightly off in specifics, specially the “inside baseball” kind that you and I may take pride in knowing but his broader theme of regulatory capture and how incumbents in healthcare (including Epic) have benefited from it is not that off base, is it?

    • Bill’s narrative fails to recognize that HITECH was the brainchild of the Bush administration – which is partly why it got included in the recovery act (oh and btw Neil and Cliff were both major GOP donors)… Inside baseball is not one side of the aisle, but HITECH just happened to be a shovel-ready initiative at the time the Obama adminsitration needed it.
      He also casts this as some evil manipulation Judy was behind and solely profited from, but in that era the field was very different, we actually had competition even it was a bit of a duopoly, Epic was not the forgone conclusion…money was made across the board and many Health Care executive millionaires/billionaires were minted. I think this revisionist history is becoming more popular as we see laggards ditch their aging Cerner and Allscripts infrastructures for Epic . If anything Cerner and Allscripts are prime examples of how the short-term expectations of Wall Street and Venture Capital can lead to a weakened position in the long run when your competition has no obligation nor need for outside capital.

  2. The real champions of regulatory capture are the health systems and physicians who needed to be bribed with Meaningful Use dollars to implement EHRs with safety features like CPOE and some minimum standards for interoperability

  3. Agreed,

    The ECW, Greenway, and Practice Fusion fines were for nothing other than fraud. Be that in fraudulently certifying functionality, or in the case of Practice Fusion promoting opioids in their ‘free’ EHR.

    They all three got caught with kickback schemes — either for recommending the product or for recommending specific opioids. And according to the ONC, NextGen was caught doing something similar. Personally, I don’t think fines are enough for that level of fraud, actual jail time is more appropriate.

    While I am no fan of Epic’s practices: lack of transparency of its algorithms, draconian non-disclosure and non-compete contracts, etc. As far as I know they are nowhere near the corruption that these EHRs showed in their business practices.

    Throwing that level of practice onto a government conspiracy to promote a competitor is nowhere near accurate.

  4. Judy’s political donations were not in the “major” threshold – not even for just Wisconsin. Many news sites totaled the donations of all Epic employees to make the false claim that she was a major contributor. This is public info so not excusable to make that up.

  5. What stood out about Gurley’s rant, in particular, and for me?

    “This happened because of the mortgage meltdown. Doctors own multiple homes, so they have multiple mortgages, so they probably needed the assistance…”

    So, one of Gurley’s theses is, that HITECH happened because doctors have multiple mortgages? That is so wrong that it is Not Even Wrong.

    That’s just stupid.

  6. The issue with the Bill Gurley piece is two-fold:

    – Some if it’s key premises and insights are just factually wrong. We might be in a “post-truth” era online, especially on social media, but the items are that wrong aren’t objective. They are subjective and simply not true. It isn’t even “inside baseball” either.

    – It is getting passed around a lot on LinkedIn and X (Twitter) and basically accepted as fact. It socializes and internalizes ideas that aren’t true about one of the key health IT vendors.

    There are plenty of valid issues to gripe or criticize the HITECH Act, EHRs, and/or Epic. No need to add additional half-truths and falsehoods.

  7. The most disappointing part of “Obamacare” was….something that happened a year before Obamacare passed? Ugh. That Bill Gurley speech was so hard to watch, just cringe-worthy with errors.

  8. Four points –
    1. Is an “Epic” possible in today’s regulatory world?
    2. How many EHRs were there in 2009? How many are there today? How many new EHRs have been developed since then?
    3. Which major benefits have accrued to patients and clinical workers since 2009 due to EHRs and are they commensurate with the $s and resources spent?
    4. Price of technology inevitably goes down (or becomes more feature rich at the same price point). Has price of EHRs (including TCO) gone up or down relative to inflation? Relative to GDP growth?

    That’s all regulatory capture and that is the broad point from Gurley.

    Of course, many of you are cringing because as the great Upton Sinclair once said, “It is difficult to get a man to understand something, when his salary depends on his not understanding it.”

    • Gurley sounds like a B.S’er. And he’s in the VC business so that tracks.

      Here’s the setup. You want investor capital and lots of it. There is a pathway to this that involves self promotion, a dynamic speaking style, outrageous theories that are unconventional and controversial, and chutzpah. Above all the chutzpah!

      When challenged on the facts, you just say something like, “it’s only a theory”, or you cite one fact that supports your story, but doesn’t actually prove it. Then you get your skeptic to do all the lengthy, boring investigation. You drive off in your fully expensed Ferrari, confident you can stay ahead of any questions.

      These folks are fun at parties, but they will never come within a million miles of my money. If Gurley knows the difference between his B.S. and reality, he might get through this life with his reputation (mostly) intact. However Pride Goeth Before the Fall!

      Most B.S’ers eventually believe their own press. For a recent prominent example, witness Sam Bankman Freid. In a telling moment, SBF’s recent defence was that he was “incompetent, not malevolent!”

  9. The part that Gurley totally missed, and I as many others lived thru it, was that in the early 2000’s the big four (Cerner, McKesson, Siemens/SMS, and Eclipsys) could not give away their patient care products – hospitals were just not eager to buy. Why? Because CEOs/CFOs did not believe there was real ROI, installs were tougher than pulling teeth, and clinical staff were very resistant to the workflow changes they demanded.

    In the early 2000’s Epic was not a big player in the hospital market but was big in the large medical practice arena, they were just beginning to get into hospital EHRs at Evanston and a few others.

    The impetus for the Meaningful Use program (HiTech act of ARRA) was a RAND study pushed by the vendors that claimed that EHRs could save BILLIONS! the MU program was created by the Obama administration and justified by reference to the RAND study.
    The big four lobbied heavily for the HITech act. By 2009 when it was enacted EPIC had solid traction in hospital EHRs and in essence came along for the ride. And boy did they ride that wave!

    The real promoter for MU was Cerner. So maybe the moral to the story is…be careful what you wish for!







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