Monday Morning Update 1/29/24

Top News

UK doctors warn that patient care will suffer under new laws that would limit their use of messaging apps such as WhatsApp and Signal for clinical use.

A journalist’s BMJ article says that a law requires that encrypted messages be placed under government surveillance by the national communications regulator to look for harmful or illegal content, rendering patient data insecure.

A law also requires that messaging app security upgrades be approved, which could take months, leading major tech providers such as Meta, Apple, and Signal to threaten to withdraw services to the UK. Wikipedia has already said it will not be able to operate under a law that tracks user identities, actions, and content submissions.

Clinical informatician Marcus Baw, MBChB says that NHS should have built its own encrypted app that connects to its email system.

Reader Comments

From Industry Recruiter: “Re: LinkedIn an ageism. Here are my thoughts.” A summary of this recruiter’s list, sent in response to my comments last week:

• It’s ideal to include a headshot on LinkedIn, taken professionally within the past 10 years, but lack of a photo doesn’t dissuade them.
• List all relevant work experience, even if it goes back more than 10 years, if it adds credibility to the industry or job you are seeking.
• Listing more credentials never hurts unless you can show no real work experience with them.
• Include at least one bullet for each job in your summary that highlights a specific accomplishment.
• Don’t make the write-up so wordy that people can’t get a good review in a minute or two. Save descriptions of skills, such as teamwork or mentoring, for the resume.
• Ask for LinkedIn recommendations.
• It doesn’t hurt to publish LinkedIn articles, but that isn’t going to shift their view from the work experience.

From Unleaded: “Re: Epic Showroom. It brings together legacy partner programs such as App Orchard, Connection Hub, and Partners & Pals. It has four key parts: (a) Supply Shot for people support; (b) Health Grid, for providers connecting to the broader ecosystem such as payers, labs, and telehealth networks; (c) Products, a three-tiered partnership list that includes a list of all third-party apps, Toolbox for specific apps like Nuance DAX that follow Epic’s integration guidelines, and Workshop for companies like Abridge that are co-developing with Epic; and (d) Cornerstone Partners, companies like InterSystems and Microsoft whose software is used significantly by Epic.”

HIStalk Announcements and Requests

Poll respondents say that General Catalyst’s biggest challenge as a venture capital firm that is buying a non-profit health system is to either swing it to long-elusive profitability or hope that its losses are made up elsewhere in its portfolio.

New poll to your right or here: Which of the following forms of discrimination do you suspect had the strongest negative influence on your career in the past five years? It’s your best guess, of course, since companies and managers who discriminate aren’t usually stupid enough to brag about it.

How to support HIStalk with practically no effort:

• Sign up for spam-free email updates that I send when I post something new.
• Connect and follow on LinkedIn and join Dann’s HIStalk Fan Club. The first thing I do if someone wants a favor is to see if we are connected or if they are among the 4,195 fan club crew.
• Mention HIStalk to your colleagues and vendors.
• Share news, rumors, and intriguing insights.

Sponsors: complete my information form for ViVE and/or HIMSS if you are participating and I’ll include you in my online guide. In the immortal words of John Blutarsky, don’t cost nothin’.

Reader comments about Medicare’s conclusion that telehealth use has dropped of to nearly pre-pandemic levels led me to look beyond the headlines:

• The Medicare Telehealth Trends Report looked at the percentage of eligible Medicare beneficiaries who had at least one Part B claim for a telehealth encounter between January 1, 2020 and June 30, 2023, suggesting that the yearly percentage has dropped from 48% in 2020 to 34% in 2021 and 29% in 2022.
• The quarterly percentage jumped from 7% in Q1 2020 to 47% in Q2 2020, then settled into a 15% or so level from Q2 2022 until now.
• Medicare didn’t report pre-COVID numbers to provide a true baseline, but a previously reported GAO review said that 0.3% of Part B beneficiaries used telehealth services in 2016, so basically nobody used it until the pandemic shut down many practices and CMS started paying providers equally for in-person and telehealth visits.
• Medicare’s numbers cover only Medicare beneficiaries who signed up for the optional, extra cost Part B that covers physician visits and outpatient care, although most people enroll in both. I’m assuming that the report also covered traditional Medicare only and not Medicare Advantage, which jumped from 39% of all beneficiaries in 2019 to 51% in 2023, but that’s a guess on my part.
• We don’t know the percentage of providers who offered telehealth services from 2020 until now, or how many beneficiaries would choose a telehealth encounter if their regular provider offered it.
• We don’t know how many Medicare beneficiaries received telehealth services that weren’t billed to Medicare.
• The recently noted surge in Medicare-covered services such as procedures – which is tanking the share price of Medicare Advantage insurers – may have temporarily or permanently reduced the demand for telehealth services as patients returned for deferred office visits.
• We don’t know how many providers discourage telehealth visits for their patients, either because they don’t like doing them or they prefer an in-person visit where additional services can be offered and billed.

Webinars

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

Acquisitions, Funding, Business, and Stock

A Boston Globe article says that while CVS Health is generating record revenue and executing a healthcare center strategy that includes its Aetna insurance, CVS Caremark pharmacy benefits management, and Oak Street/Signify provider businesses, profits are down because its core business of drugstores suffers from lower payments, a shortage of pharmacists, general labor shortages that create customer lines, widespread store closings, and the perception of dirty and poorly managed locations. The company blames PBMs for their efforts to reduce prescription costs, one of which is its own CVS Caremark, which controls 33% of that market.

Announcements and Implementations

JAMA Network publishes an interview with UCSF’s Atul Butte, MD, PhD, who is chief data scientist over the entire University of California Health System:

• UC’s 11-year repository of Epic data covers 9.1 million patients across 10 hospitals, 1.5 billion drug orders, 40,000 cancer genomes, and 50 million medical devices.
• He says that health systems will want to undertake similar work to develop standard medical practices that reduce care variation.
• UC uses “leave one medical center out” cross-validation, where they leave out one medical center when performing analysis and then see if the conclusions from the rest pan out for that remaining hospital.
• The organization will work with drug and AI companies only if its own patients benefit.
• He foresees a day when EHR-trained AI can be deployed to doctors via order sets and decision support tools and even to patients, who might have their own decision support tool on their smartphone. He says that big health systems will probably developed their own branded AI assistant, but their data could be used to help hospitals that don’t have those resources.
• Butte says he personally uses AI to write letters of recommendation, emails, and programming code.

In England, surveyed NHS doctors report that physician associates, who are being used to replace doctors despite having completed only a two-year post-graduate program, are prescribing drugs illegally and missing critical diagnoses. Physicians object to the plan to regulate PAs alongside physicians, and doctors report that PAs – who are renaming themselves from “physician assistant” to “physician associate” — are introducing themselves as doctors to patients. Meanwhile, a physician X user doctor calls PAs “noctors” (not a doctor), with screen shots showing a Royal London Hospital PA who brags on signing DNR forms and conducting an Instagram poll to decide how to perform an exam.

Cardiologists recommend in JAMA Cardiology that clinicians be mandated to capture SOGIE data (sexual orientation and gender identity and expression) in EHRs to help researchers understand the cardiovascular health of LGBTQ+ adults.

Privacy and Security

Ontario’s Bluewater Health restores its hospital systems that have been down since an October 23 cyberattack that affected five hospitals that had formed an IT shared services group. The hospital says legal implications prevent it from saying which parts of Meditech remain down, but confirms that it will be replacing the 20-year-old system with Oracle Cerner by the end of the year.

In the UK, former prime minister Tony Blair and former Conservative Party leader William Hague call on NHS to sell de-identified patient data to AI companies to use for training to develop patient monitoring tools. They also envision an NHS app that would give patients access to their own information and capture more data to sell. They call for NHS to set up a new data trust company that would oversee privacy in commercializing access to the information.

Other

An NHS doctor who was flying to a skiing vacation responds to the flight crew’s call for a doctor to assess a 70-year-old passenger’s health problems. The plane wasn’t equipped with a pulse oximeter, so he used a crew member’s Apple Watch to determine that the woman had low blood oxygen levels, which he successfully treated with oxygen. He praised the Ryanair staff afterwards, adding a recommendation that all plans carry emergency physician kits that include tools for basic measurement, diabetes, blood pressure, and oxygen saturation. He luckily borrowed an older watch since a patent dispute has forced Apple to disable the pulse oximetry function that he used in recently sold Apple Watch models.

Sponsor Updates

• SnapCare will provide contract staff transparency in its workforce marketplace, where it will itemize pay rates, travel costs, a standard rate that covers benefits and payroll taxes, and the company’s fee, saving clients an estimated 15%.
• NeuroFlow publishes a two-part case study featuring the success EvolvedMD found using NeuroFlow’s technology as a part of its efforts to integrate behavioral and physical healthcare services for its customers.
• Frost & Sullivan recognizes Wolters Kluwer Health as an “Innovation & Growth Leader” in clinical decision support systems.
• Centerpoint Health leverages data from the EClinicalWorks EHR and its Healow no-show prediction AI model to improve its clinical workflows.
• Vyne Medical releases a new customer success story, “Streamlining Fax Operations: A Growing Medical Center’s Success Story.”
• Revuud shares its key highlights of its 2023 performance, including 16 new customers.
• Symplr publishes its “Provider Credentialing 2024 Guide.”
• Waystar will exhibit at the HFMA Minnesota Winter Conference January 30-31 in Minneapolis.

Blog Posts

• Modernizing your digital front door to serve both patients and staff (Notable)
• E-Cloud Automates Well-Architected Framework Reviews with MontyCloud (Optimum Healthcare IT)
• Five Best Practices for Using Credentialing Workflows – Part Two: Proactively Establish Ownership (QGenda)
• CMS prior authorization rule finally crosses the finish line (Redox)
• Best Practices for Upgrading Mirth Connect: A Zen Healthcare IT Discussion (Zen Healthcare IT)

Contacts

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