Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Monday Morning Update 11/4/24
Top News
Maven Clinic, which offers virtual women’s and family health services, reportedly lays off 10% of its headcount weeks after it raised a $125 million Series F funding round at a $1.7 billion valuation.
Employees say on online forums that the layoffs are in preparation for an upcoming company IPO.
Maven posted an article last year about “Workplace Survivor Syndrome” that wrapped up with “How Maven can help you support employees following layoffs.”
Reader Comments
From Jerry Rigged: “Re: Oracle Health. Aren’t they just using a code generator to transform Millennium to new technology?” That was the original plan, but now it sounds like they are developing from scratch, or at least spiffing up the front end without changing the functionality and data schema. Competing with Epic will require more than just an improved UI with some AI thrown in – Epic could match that if it thinks that’s what the market wants. The “crumbling infrastructure” comment isn’t exactly confidence-inspiring to existing customers who Oracle expects to stick around while they create a replacement product like other big outsiders have previously failed to do.. Maybe someone can answer these questions:
- How much of Millennium’s functionality will be included in the new product, and how will integration work with those modules that won’t be part of the initial release? Pharmacy, surgery, pathology, and radiology have to be complete and error-free.
- How will the new system address existing user customization?
- Will the problematic revenue cycle system be rewritten, and if not, how will the existing one integrate with the new EHR? Why would you not first fix RCM when its weaknesses are obviously hurting product sales and retention?
- How will CCL customization, rules and alerts, MPages, and custom interfaces be addressed?
- How will users interact with the system if they don’t like voice navigation or it doesn’t work in some situation?
- What’s the incentive for an existing customer to serve as a beta site?
- How long will it take for the new product to get market momentum, which will require convincing some number of Epic customers to de-install? Epic is expensive and organization-altering – not to mention that de-installs have been few – so what’s the best guess of the length of the buying cycle where Oracle Health could be back on the table?
From Robert D. Lafsky, MD: “Re: NEJM article. Good, although I would dispute how much AI can make the derp filling up most of my shared EMR any worse. Although several primary care colleagues are using AI assistants in the room, I stubbornly stick with dictating a narrative and some concluding clinical reasoning using Dragon. If only their AI geniuses could figure out how to get it to distinguish between the words ‘in’ and ‘and’ it would be nearly perfect.” The NEJM perspective piece makes these points:
- The problem-oriented, click-driven medical record was supposed to help clinicians by organizing information to support decision-making, but has placed limits on conveying the “patient’s story” and hasn’t been proven to have improved quality.
- AI-generated chart information could reduce the quality and reliability of documentation.
- The clinician’s reasoning might be diminished if AI creates the documentation without requiring them to synthesize the information themselves.
- Transcription and chart summarization seem like low-risk uses of AI, but may not perform as well as clinicians in conveying which information is relevant and creating a concise clinical impression that conveys the clinician’s degree of confidence.
- AI is confident even when it is wrong, making it harder for clinicians to detect hallucinations.
- AI excels in a free-form environment, meaning that it might have worked better with old-school paper records rather than with EHRs.
- AI models may collapse when they are fed training data that was generated by AI in the first place.
HIStalk Announcements and Requests
HLTH attendance isn’t beneficial to patients and healthcare in general, according to 81% of poll respondents overall and two-thirds of those who actually attended. Steve says that the conference is more geared toward getting investors and CEOs in the same room, while UnHLTHy says that HLTH ends up being companies that are trying to sell stuff to each other – an exhibitor told them that just 270 providers were on the list of 9,000 attendees.
New poll to your right or here: What will be Oracle Health’s biggest challenge in developing a new EHR? Those of us who have been involved in designing or implementing a new clinical software product could have extended the choice list by dozens, but I tried to keep it high level.
Congrats to everyone who proudly sticks to always tagging times as “EST” — you have finally entered the 33% of the year when you are not wrong. Pro tip: switch to just “ET” and you’ll be right 100% of the time. Beyond the time change that affects all Americans except for those in Hawaii and most of Arizona, I wish you a belated happy Halloween, Diwali, and Día de Muertos.
I accidentally found some useful LinkedIn options given that I have never checked my profile settings. Click “Settings & Privacy” under your profile picture on the top toolbar, after which you can do several things:
- Turn off autoplay videos.
- Turn off sound effects.
- Don’t show profile photos of people who aren’t either a connection or in your network.
- Turn off seeing political content in your feed.
- Choose “most relevant” or “most recent” posts for your feed view (I changed to the latter).
- Under Settings/Visibility, you can also choose to hide your name when you visit someone’s profile, turn off the ability for connections to see your connections list or people you follow, hide your last name, and hide profile visibility from outside LinkedIn.
- Under Advertising data, you can turn off a bunch of options that LinkedIn uses to target ads and disallow showing personalized ads from outside of LinkedIn.
Thanks to these companies that recently supported HIStalk. Click a logo to learn more or contact Lorre to join the list.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Acquisitions, Funding, Business, and Stock
UK-based Definition Health, which offers surgical workflow software, raises $7.5 million in pre-seed funding.
Cigna reports a “non-cash investment loss” of $1 billion related to its $2.5 billion investment in VillageMD in November 2022. The company wrote off nearly $2 billion of that investment in May 2024 when VillageMD majority owner Walgreens started closing its clinics.
Sales
- Children’s Mercy Kansas City begins its implementation of Epic, which will replace Oracle Health.
Announcements and Implementations
Oracle Health and Meharry Medical College announce plans to create a health technology education and research collaborative, a health innovation hub, and a community care and wellness center in Nashville.
Privacy and Security
In Ireland, whistleblowers report confidentiality concerns that employees of Children’s Health Ireland are using the GoToMyPC remote desktop software on personal phones and laptops to access confidential patient information on hospital systems.
Other
The rapidly aging population of Hong Kong, combined with China’s goal to care for 97% of its elderly citizens at home, is driving digital health innovation. Biometric sensor companies have developed wearables that monitor heart rate and blood oxygen levels, diagnose sleep apnea at home, function as non-prescription hearing aids, and detect heat stress. The company Well Being Digital focuses on earbud sensors, citing studies showing that earbuds are more commonly worn than watches or rings and offer more stable, accurate measurements compared to wrist- or finger-based devices. Additionally, earbuds – which the company calls “hearables” – allow interactive and intervention features, such as direct clinician communication.
Sponsor Updates
- CereCore will participate in the CHIME Fall Forum this week.
- WellSky and the National Association of State Directors of Developmental Disabilities Services publish the results of a survey that assess the readiness of states to comply with CMS’s Ensuring Access to Medicaid Services final rule.
- Optimum Healthcare IT publishes a data and analytics governance capability maturity model.
- Clearwater and Guidehouse partner to offer solutions that help healthcare organizations mitigate cybersecurity risk.
- Vyne Medical publishes a case study titled “How Hurley Medical Center Expanded Services to Increase Access to Care.”
- Inovalon announces the winners of its 2024 Inovalon Impact Awards.
- Optimum Healthcare IT posts an episode of its “Healthy as Tech” podcast titled “4 Ways to Increase Epic ROI With ServiceNow.”
Contacts
Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.
What will be Oracle Health’s biggest challenge in developing a new EHR?
all of it, ALL of it
This topic intrigues me. Seriously, what could Oracle do, to make inroads against Epic? Something short of, and in a different direction than, “spend $100 million and 10-15 years before you have anything that can go head-to-head against the market leader”?
My thoughts are, Oracle would need to target areas that are known trouble spots in the EHR market. Consistent points of friction. Therefore, and in no particular order:
– maybe RCM is completely the wrong focus. I have heard complaints, both general and specific, that Such and Such system is revenue obsessed. These complaints usually lead to an idea that the focus should be clinical as opposed to financial;
– we routinely hear complaints from physicians, that documenting takes too much time and draws attention away from the patient. OK, follow that. Make a system that is unobtrusive overall, and actually seen by the physicians as essential (and irreplaceable!) by the physicians. If you could do that, I’m convinced there would be a market;
– maybe pick a clinical area or two, and solve that. Ignore the rest for the time being. Since Best of Breed has fallen out of favour, make interfaces your priority, and export your data to generalist systems. This might make BoB systems viable in the current market;
– building on the previous point, the long-term play would be to slowly expand functionality to additional clinical areas, winning customers over with superior functionality. Slowly eat away at the generalist systems;
– Now, this would be an uncomfortable pill. But the market leaders right now have a reputation for being expensive. If you could sell this system at a discount, that would make your marketing SO much easier. It doesn’t have to be cheap, just less expensive.
Here’s my pitch for what Oracle can do.
Right now, Cerner cant compete inside the US on big contracts due to rev cycle, and Meditech has a better, cheaper contract for small contracts. International contracts are all for governments and the three vendors are pretty comparable. Epic is the most expensive and Oracle/Cerner are good at winning government contracts, so they have an opportunity there.
Buy Meditech.
It’s uniquely a good time to do it due Meditech ownership turnover. Meditechs long term business model won’t work, because they can’t generate the profit to reinvest into an innovative product. Taking out Meditech will allow Cerner to compete at the low end without actually executing, which Cerner has proven they can’t do. HCA is the only big customer Meditech has left, plus a bunch of international customers. Keep the experienced Meditech personnel with the knowledge, and quit hiring expensive Boston employees who immediately quit for greener pastures. Outsource the gov contracts and Meditech to India. The cost to develop AI, telehealth, an alternative integration to Change Healthcare, etc. drops as you share developers across the product suite
The government sees the monopoly developing and starts taking regulatory interest. You force the governments hand essentially. As the firmly entrenched underdog, this benefits Oracle Cerner Meditech.
You focus on international contracts using your lower cost of customization due to outsourcing. Oracle databases are embedded in goverment IT everywhere for a reason; they have the best lawyers, lobbyists, and salespeople. You win internationally and you own the cheap end of the market.
Let’s say in ten years, healthcare reform takes off and all of the margin is cut out of the American healthcare system, and therefore the global system as well. Investment in IT drops, no one can afford Epic , and the market stagnates. You own half the market at a higher operating profit margin than Epic. Epic has maybe lost its leadership and stumbles. You stick it out and win.
That’s the story. No innovation, no AI, no greater good – just ruthless shareholder capitalism.
I like much of what you wrote, with one exception: AI.
I’d make AI a marketing highlight of the new EHR. Slap it on everything! Even if the implementation occasionally amounts to little more that a giant If… Then… Else… statement, call it AI.
Actually though, I’d hedge my bets. What if AI turns out to be a flash in the pan, like fuzzy logic was? And even if AI turns into a durable, reliable, general-purpose technology? I’d still hedge.
Sell the tech benefits instead. Call them “Clinical Assistants” or “Electronic Scribes” or “Documentation Buddies”. Something that sends a message of direct user benefit. And if the AI craze tanks, you are insulated from that.
Good Linked In tips. I would say it’s been very disappointing to see political posts on this platform. As Lincoln once said “Better to remain silent and be thought a fool than to speak and remove all doubt”.
Sadly we can blame Elon Musk for this, He killed the best part of Twitter and now many have migrated to Linkedin. Meanwhile half the country has joined a cult which does upset some of us who know something about authoritarian governments, hence politics is appearing on Linkedin
Twitter and Linked In are apples and Volkswagens – Twitter has never been a platform for professionals.
While Twitter may not have been a place to tout your resume and accomplishments, there was in the day very robust conversation communities – medtwitter, HCLDR, HIT etc that were active and interesting. It’s how I first came across Matthew. I also was able to see what vendors, researchers, VCs, etc were doing and thinking in this space. That’s all gone.
And I guess we can blame @Matthew Holt for doing the same thing in the comments of HIStalk?
Just a week ago, you posted on LinkedIn how the electoral college needed to be abolished because it was unfavorable to your preferred political candidate. Maybe sit this one out? Glass houses….rocks….all that?
Re: Tun off options on LinkedIn. Good advice, thanks for sharing. This goes for every other tech platform and website in existence.
No I don’t want to allow notifications
No I won’t share my location
No I don’t want your stupid AI button, option, or assistant
I could keep going.
Heard that all of our sites are moving to Epic. We have started hiring internally already. Don’t know if this is a result of “crumbling architecture” comment.