Readers Write: Thirty Years in Healthcare IT, An Accidental Pilgrimage

Thirty Years in Healthcare IT, An Accidental Pilgrimage
By Jim Fitzgerald

Jim Fitzgerald, MBA is founder and EVP/chief strategy officer of CloudWave of Marlborough, MA.

Friday is my last day at CloudWave, my latest and likely last team in which I labor full time in the healthcare IT space.

Whether you work at a healthcare provider, an industry software vendor, or a managed cloud services company like ours, healthcare IT is by nature a team sport. It is also often as much a vocation as a career. There are darned few deep thinkers, deeply technical people, or talented managers in HCIT who could not make more money outside of it. But on the flip side, could probably not muster the directed passion for the work outside of HCIT.

That has been a recurring theme from the time I entered this business in 1993 by joining a firm weirdly and appropriately called JJWild. Everything along the way needed to be designed, built, and managed so that to the greatest extent possible it could ease and empower the safe delivery of healthcare,while being where possible, “minimally invasive.” You would have to be a heartless megalomaniac (not that we notice many on the world stage these days) not to be able to buy into that mission. After all, short of a handful of blessed protected natives sequestered deep in the Amazon who have never had to read an Explanation of Benefits, we are all healthcare consumers. Some combination of spiritual awareness, concern for our neighbors, and enlightened self-interest continues to drive the space as powerfully as financial motives. At least I hope so.

What was the road like? In 1983 (yeah, I’m that old), I was working in a non-healthcare oriented technical and marketing support role at a modem company called Microcom. Our modems were unique in that the analog / digital conversion and signaling engine was overlaid on a Z8 breadboard with a whopping 64K of RAM that booted its own device OS and loaded code from EPROM that allowed the serial interface to be programmable and also allowed the modems to run their own in-band data communications protocol to protect the data stream.

This caught the attention of a rapidly growing HCIS vendor called Meditech, whose founder, Neil Pappalardo had invented a proprietary color terminal for their Magic OS that would deeply impact the industry. The appealing interface could do block and character color graphics at about 20% of the cost of a PC and almost no maintenance. The catch was that for remote data access, it needed a connection between the terminal and the remote terminal server that had no data communication errors, as the terminal server and the terminal were in constant “chatter,” both to transmit and receive HCIS data and to manage screen formatting and behavior.

That’s how I got to know Meditech, and it changed my path. Nine years later, I joined the team at JJWild at the urging of one of Meditech’s system gurus, Chris Anschuetz, whose simple explanation was, “We are moving from Magic to TCP/IP. Our customers are going to need open networks and we need partners who can build them.”

My personal education on TCP/IP had come from a product manager at Microcom, Eugene Chang, an MIT engineer with a gift for making the complex simple. He had helped build DARPANET while at the semi-legendary consulting firm Bolt, Beranek, and Newman. I was excited. Shortly thereafter I found myself counting wires in hospital closets, ceilings, repurposed laundry chutes, and ceiling chases. Lab visits were always the frightening highlight of those network walkthroughs.

One thing led to another. JJWild helped Digital Equipment / Compaq introduce the Alpha to the Meditech community. Data General, Meditech’s larger systems partner, got sold to EMC. JJWild started offering applications, tech consulting, and managed disaster recovery services to hospitals.

Oddly, this tech support guy turned sales engineer turned sales guy (also known by “pure” engineers as the path to the dark side) was kicked into a CTO role at JJ to cap my cost to the organization. It was insane in scope, but could be a lot of fun. I got to work with a large cross section of the company – sales, consulting, engineering, support, and partner management — while still being able to work daily with our hospital customers. A group of us from inside and outside the company constantly debated and schemed to figure out how to build unbreakable systems to support healthcare apps. We got support to launch a private cloud-based disaster recovery service, JSite, at JJWild.

Perot Systems gobbled JJWild up in 2007 and put us to work before the ink was dry on harnessing emerging cloud tech to host legacy healthcare apps. A hosting solution called MSite was introduced by Perot in 2008. Dell bought Perot in 2009 with the intent of becoming more services-oriented, but the Meditech team at Perot barely showed up on their financial radar at the time.

When it became clear we were not a core strategy for Dell at the time (they sold Perot to NTT Data in 2013), 27 of us quietly left Dell from October 2011 to May of 2012 and joined with Park Place International. Its founders agreed to fund a new hybrid cloud managed services venture that would evolve into CloudWave and a suite of secure, highly available managed services called OpSus that today hosts over 125 diverse applications from EHR to enterprise imaging for more than 200 hospitals, securely backing up petabytes of data to both public and private cloud, and disaster recovery protecting over 175 hospitals.

Our services, with a cross-cloud platform sourced from our own secure private cloud data centers as well as AWS and GCP, began to transcend the Meditech realm and are gaining new customers from hospitals running Epic and Cerner, as well as smaller ISVs who need somebody to provide an ops center that can “take them to cloud.”

What do I see coming? The 20-year cycle in IT that goes from everything centralized to everything decentralized will continue and perhaps compress. The ongoing migration to cloud is driven by economic, operational, and security forces and will continue, but the cloud edge will also get built thoughtfully to support advances in genomics, analytics, and machine learning. Either PHRs will become real and the consumer will be their own best health data steward, or the vaguely and mostly unintentionally evil government / medical / pharmacy / insurance megaplex that wants no one to really have a private life will win and someone other than you will own your EHR.

Consumers will reassume financial responsibility for their own healthcare with some kind of underlying insurance for big bills or will surrender to a central system that doles out equal misery and lack of excellence for all. Black hat hackers will be heavily prosecuted instead of modestly slapped and sent to abandoned monasteries to do something useful for the rest of their days, like crush wine grapes with their feet. All but the largest integrated healthcare systems will get out of the IT business in a similar fashion to how they got out of the laundry and food service businesses and buy IT services modularly, the way individuals mix apps on their tablets. No matter where you sit in the space, it’s still going to be a wild ride.

What have I learned? Most hospital IT teams I have worked with over the years are understaffed, underpaid, and hugely dedicated to their work. They have capacity for X projects per year, demand for 3x projects, and funding for X/2 projects. They adapt like ADHD chameleons traversing a mosaic. Intended and unintended poop is flung at them by regulators, vendors, colleagues, and customers.

You are collectively some of the best people I could have hoped to serve. Thank you for the privilege.

Morning Headlines 3/30/22

Novant Health launches new business division to accelerate clinical, operational and technological advances for the healthcare industry

Novant Health (NC) launches Novant Health Enterprises, an independent business focused on developing, acquiring, and scaling clinical, financial, and patient-oriented solutions.

With tech launches, Epic Systems looks to future of healthcare accessibility

Epic expands its 1,100 acre campus in Verona, WI with the opening of its 350-office Mystery building, the forthcoming opening of its Castaway building, and the addition of three more facilities within the next five years.

Life Sciences and Healthcare Leader ConcertAI Raises $150 Million Series C from Sixth Street at $1.9 Billion Valuation

Enterprise AI and real-world data software vendor ConcertAI raises $150 million in a Series C funding round, bringing its total raised to over $300 million.

News 3/30/22

Top News

AmplifyMD, which connects hospitals to specialists via telemedicine, raises $23 million in a Series A funding round. The San Francisco-based startup’s software also incorporates care management, billing, and analytics.

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

On demand: “Cybersecurity Threats Facing Healthcare Today.” Sponsor: Net Health. Presenters: Jason James, MS, CIO, Net Health; Monique Hart, MBA, CISO, Piedmont Healthcare; Jeffrey Rosenthal, , MBA CIO, Reliant Rehabilitation; David Jollow, MBA, CISO, Healogics. The panel of CIO and CISO leaders will discuss the cyberthreats that healthcare faces today. They will review security priorities for the increasingly complex healthcare IT environment that includes cloud-based applications, an increased number of endpoints that include connected devices and patient wearables, and patient portals.

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

Acquisitions, Funding, Business, and Stock

RCM software vendor NThrive will change its name to FinThrive. The company acquired TransUnion Healthcare late last year for $1.7 billion, and is in the process of purchasing Pelitas, which specializes in patient access, intake, and RCM software.

Change Healthcare will reportedly sell its ClaimsXten claims payment and editing software business to Availity as potential acquirer UnitedHealth tries to work through DoJ antitrust concerns. Legal experts suggest the sale of ClaimsXten may weaken the DoJ’s lawsuit against the proposed sale of Change to UnitedHealth. The companies have until April 5 to walk away from the $8 billion deal.

Novant Health (NC) launches Novant Health Enterprises, an independent business focused on developing, acquiring, and scaling clinical, financial, and patient-oriented solutions.

Cardiologist John Spertus, MD files a copyright infringement lawsuit against Epic claiming that it has made some of his diagnostic questionnaires available in its EHR. Spertus is the director of health outcomes research at Saint Luke’s Mid America Heart Institute in Kansas City, MO.

Sales

• In Ireland, Mater Private Network will implement Meditech Expanse across its hospitals and clinics.
• Digital home care company Vesta Healthcare selects Bluestream Health’s virtual care platform-as-a-service.

People

David Garets, whose long health IT career included leadership roles with Gartner and HIMSS Analytics, died Monday at 73.

Inderpal Kohli (Hospital for Special Surgery) joins Englewood Health (NJ) as VP of IT and CIO.

Other

A local website’s profile of Epic Systems hints at a forthcoming app that will enable physicians to research best patient care practices using real-world evidence culled from the company’s Cosmos dataset, and outlines the company’s plans to continue expanding its 1,100 acre campus in Verona, WI. It opened its new 350-office Mystery building last week, and will open a similar building, dubbed Castaway, later this year. Three more additions will open within the next five years.

Vanderbilt University Medical Center’s Clickbusters program has helped reduce alert fatigue through a six-month review process that has modified 42 clinical decision support alerts and turned off 10. Eighty-four alerts were reviewed by physicians, nurses, and pharmacists, ultimately resulting in 71,227 fewer interruptive alerts being sent per week, and a 15% reduction in total interruptive alerts.

Sponsor Updates

• The Ascom marketing team has worked with Habitat for Humanity to paint two houses in Cary, NC.
• Healthcare IT Leaders publishes a new managed services case study featuring Northeast Georgia Health System.
• AdvancedMD awards Client Support Specialist Hannah Dixon an FIT Award.
• Arcadia publishes a new case study, “How Summit Health’s transitional care management creates value for patients and practices across multiple payment models.”
• Baker Tilly will present at the Pennsylvania Association of Directors of Nursing Administration Convention March 29-April 1.
• Bamboo Health will present at the Rx Drug Abuse and Heroin Summit April 19 in Atlanta.
• Dina will present at the TAG Digital Health Summit March 30 in Atlanta.

Blog Posts

• Debunking three common misconceptions about gateway edits (Availity)
• How a Virtual Care Platform as a Service enables better care (Bluestream Health)
• What orthopaedic surgeons need to know about surprise billing legislation (Bravado Health)
• Unleashing the Power of Communications for Healthcare (CareMesh)
• 5 Qualities That Add Value to a Managed IT Services Partner (CereCore)
• Why RHCs and FQHCs Should Care About Chronic Care Management (ChartSpan)
• 7 Things Healthcare Leaders Should Know About 405(d) HICP (Clearwater)
• It’s Time to Rethink Healthcare Data Backups (CloudWave)
• Clinical Research Study Aims to Improve Obstetric Outcomes in Uganda (Current Health)
• HIMSS22 Outlines Opportunities in Healthcare (EClinicalWorks)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 3/29/22

AmplifyMD snags $23m in F-Prime-led Series A

Specialty telehealth startup AmplifyMD raises $23 million in a Series A funding round.

Clearlake Capital-Backed nThrive Announces Name Change to FinThrive as Part of a Forthcoming Rebrand

Following its acquisition of TransUnion Healthcare late last year, RCM software vendor NThrive will change its name to FinThrive.

Change Healthcare said to announce buyer for ClaimsXten business as soon as next week

Change Healthcare will reportedly sell its claims payment and editing software business to Availity as potential acquirer UnitedHealth tries to work through DoJ antitrust concerns.

Private equity firms back Ensemble Health Partners in $5B+ deal

RCM software and services company Ensemble Health Partners secures funding from Berkshire Partners and Warburg Pincus that pushes its value to $5 billion.

Curbside Consult with Dr. Jayne 3/28/22

The only thing being discussed in the virtual physician lounge this weekend was the trial of Tennessee nurse RaDonda Vaught, who was found guilty of criminally negligent homicide following a medication error. Criminally negligent homicide is a lesser charge than reckless homicide, of which she was found not guilty.

For anyone who hasn’t been following the story, the short version is as follows. Vaught, who was a nurse at Vanderbilt University Medical Center, was managing a patient order for the drug Versed. The patient had been admitted to the hospital’s neurological intensive care unit following a brain bleed. The drug was ordered to help manage anxiety and claustrophobia prior to a PET scan. Vaught couldn’t find Versed in the automated medication dispensing cabinet and used an override to unlock a broader menu of drugs, leading her to obtain the drug vecuronium instead. Versed is the brand name for the sedative midazolam. Vecuronium is the generic name for the drug Norcuron, which is used to aid in “surgical relaxation” for general anesthesia or to create paralysis for patients who are on ventilators in the intensive care unit.

Vaught failed to validate the name of the drug, didn’t notice a warning on the medication vial itself, and didn’t stay with the patient after administration.

Vaught’s attorneys argued that although she admitted making errors with the medication, those errors were part of normal operations at Vanderbilt and reflect systemic dysfunction. Prosecutors alleged that she ignored multiple warning popups, including one that would have said the drug was a “paralyzing agent” and that would have required a reason for the override. Other nurses working on the same unit testified that overriding the medication dispenser was a common occurrence and that a recent EHR upgrade had created delays in obtaining medications from the cabinets. They cited organizational emails instructing nurses to override warnings to reduce delays. Additionally, there was no barcode scanner in the imaging department, where the medication was administered. A scan of the patient’s hospital ID bracelet against the medication might have prevented the fatal drug administration.

As a clinical informaticist and process improvement specialist, I think about these kinds of errors all the time. Our system of having both generic and brand names for drugs causes a lot of confusion. I trained in a residency program where we were only allowed to refer to drugs by their generic names, which probably prevented some errors by newly minted physicians. However, when I entered private practice, there was a lot to learn, as many of my patients referred to their drugs by brand name. I ran across a couple of situations where the patient was on two drugs from the same class that would have been caught had the generic names been used. Fortunately, none of the patients were harmed before we could modify their regimens.

This error also brings up the issue with “look alike” or “sound alike” drugs. In the EHR realm we’ve taken steps to manage the former with interventions such as Tall Man Lettering for drug names ,which help to differentiate names that are close. One could argue that Versed and vecuronium aren’t close other than that they both start with the letter V, but it’s important to understand the level of baseline confusion that might exist when hundreds of drugs are used within a patient care unit on any given day. The practice of medicine has become significantly more complicated over the last two decades with hospitalized patients often being “sicker” than they were in the past. Due to medical advances, patients who previously might have died are living longer, often with a dozen or more drugs to address their health conditions as well as to mitigate issues caused by the drugs themselves.

There are also issues with the setup of the automated drug dispensing cabinet. At the time, the Vanderbilt system only required two letters to be entered to access a drug menu. One organization I worked with had their cabinets set to require five letters to locate a drug. They also had all paralytic agents in a specially colored locked container to make it clear that nurses were accessing something that required additional diligence. Additionally, Vaught was administering medications outside her usual department and didn’t document the administration of the drug. Its lack of inclusion in the medical record led to a death certificate that noted a natural death following a brain bleed rather than being related to the medication administration.

Vanderbilt didn’t report the medication error to the state. Only a year later when an anonymous tip was sent to state agencies did an investigation begin.

Anyone who has practiced in a complex care environment, such as an intensive care unit, understands how even a small distraction can have significant consequences. As a sleep-deprived resident physician, zoning out even for a second could mean missing a critical part of a patient’s information. In past times, ICU nurses may have cared for one or maybe two patients. Today I see them caring for three or more patients, which certainly isn’t helping with attention issues or distraction.

In a hearing before the Tennessee Board of Nursing, Vaught stated that she was distracted while precepting a trainee, but admitted responsibility for the incident. Although this incident occurred long before the COVID-19 pandemic, I can only imagine the level of distraction that nurses faced over the last two years.

In response to this case, I hope all facilities are reevaluating their processes for overrides on automated drug dispensing cabinets and how they store critical drugs such as vecuronium. In speaking with a pharmacist friend about this case, she noted that not all hospitals have increased their search requirements to five characters as my client did. If you’re at one of those institutions, I’d encourage you to quickly prioritize an evaluation of your processes.

This case is a perfect example of the Swiss cheese model of process safety. The more holes that are present, the easier it is for a mistake to happen. When the holes are particularly large, such as when medication overrides have to happen on a daily basis, people become desensitized to the safeguards that are designed to protect patients.

Certainly there were individual actions that led to this tragedy. Policies weren’t followed and literal bright red warnings were ignored. But without the combination of circumstances, the patient would not have received the wrong medication.

Those of us on the clinical front lines have all made mistakes. Some of those mistakes become near misses because of systems that protect patients (and also us as caregivers). But some of those mistakes become true medical errors that have devastating consequences. Comments from my peers run the spectrum from “it’s all Vanderbilt’s fault” to “she deserves the death penalty.” The reality though is that we could all benefit from a closer look, as well as a slower and more thoughtful one, at how a situation like this might unfold in our worlds.

Have you ever been responsible for a medical error? What advice would you give for those who design and maintain the systems upon which you rely? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/28/22

DOJ joins whistleblower case against EHR vendor Modernizing Medicine and co-founder

The US Department of Justice joins a whistleblower lawsuit brought against Modernizing Medicine (now ModMed) and its CEO that accuses ModMed of falsely attesting that its EHR met Meaningful Use criteria, which caused users to submit inaccurate reports to CMS in earning MU incentives.

Cloud21 receives major investment from US healthcare technology consultancy, Tegria, to deliver digital transformation at scale

Tegria makes an unspecified “major” investment in England-based digital health consulting firm Cloud21, whose customers include several NHS hospitals.

Chapel Hill startup focusing on healthcare analytics, raises $2.5M, to expand

Quinsite, a healthcare analytics startup that markets its software to radiology practices, raises $2.5 million in seed funding.

Monday Morning Update 3/28/22

Top News

The US Department of Justice joins a whistleblower lawsuit brought against Modernizing Medicine (now ModMed) and its CEO Daniel Cane.

The lawsuit, which was filed in 2017 by former VP of Product Management Mandy Long, accuses ModMed of falsely attesting that its EHR met Meaningful Use criteria, which caused users to submit inaccurate reports to CMS in earning MU incentives.

The lawsuit claims that the company ignored patient-endangering software defects in favor of developing new products to increase revenue; illegally paid kickbacks; and sold systems with promises of increasing provider revenue that were enabled by inappropriately upcoding E/M codes and procedure code modifiers.

Reader Comments

From Friend to Nurses: “Re: burned-out nurses. HCIT needs people with clinical experience, not wild ideas from Silicon Valley, and I have several friends who are in their early 30s with 10+ years of nursing experience. Do your readers know of companies that are hiring nurses, or perhaps would companies step up here and say they want to hire nurses?”

From From Great to Horrible: “Re: Tegria.Laid off at least 50 people Friday with no warning or explanation. As someone who became an employee via the acquisition of Bluetree, it hurts to see an organization transform so quickly from having an amazing culture to one that most people dread working for.” A company spokesperson provided this response to my inquiry: “Tegria is implementing changes to better serve our customers and streamline our organization. Like all companies, we evaluate our business on a regular basis in response to ever-changing market needs, which can involve reductions in some roles and hiring in other roles.”

From Payola Pavlova: “Re: companies paying for running their own ‘news.’ Here’s a new example.” It’s not new that some industry sites are auctioning off their editorial space (and ethical principles) with the zeal of Nascar plastering ads on race cars. It doesn’t bother me in health IT as long as it’s made clear, as in this case with the prominent “sponsored” label, that objectivity was bribed to look the other way.

HIStalk Announcements and Requests

Three-fourths of poll respondents say that patients don’t get ROI in indirectly paying for attendance at industry conferences, including 58% of those who attended ViVE, HIMSS22, or both.

New poll to your right or here: What will your employer focus on most in 2022 to ensure long-term success?

Welcome to new HIStalk Platinum Sponsor Net Health. Net Health Employee Health and Occupational Medicine offers total compliance tracking and employee wellness oversight in one specialized and paperless documentation solution. Rely on integrated telehealth technology to provide care and services across locations. The Pittsburgh-based company provides EHR software and predictive, actionable analytics for medical specialties, including rehab therapy, wound care, home health and hospice agencies, and employee health. Its solutions are trusted by 23,000 facilities, including the nation’s leading hospitals, skilled nursing facilities, senior living facilities, home health and hospice agencies, and outpatient clinics. Thanks to Net Health for supporting HIStalk.

I found this Net Health explainer video on YouTube.

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

On demand: “Cybersecurity Threats Facing Healthcare Today.” Sponsor: Net Health. Presenters: Jason James, MS, CIO, Net Health; Monique Hart, MBA, CISO, Piedmont Healthcare; Jeffrey Rosenthal, , MBA CIO, Reliant Rehabilitation; David Jollow, MBA, CISO, Healogics. The panel of CIO and CISO leaders will discuss the cyberthreats that healthcare faces today. They will review security priorities for the increasingly complex healthcare IT environment that includes cloud-based applications, an increased number of endpoints that include connected devices and patient wearables, and patient portals.

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

Acquisitions, Funding, Business, and Stock

Tegria makes an unspecified “major” investment in England-based digital health consulting firm Cloud21, whose customers include several NHS hospitals.

Sales

• OmniLife chooses Redox for EHR integration of its newly developed referral and status update modules to its transplant center platform.

People

Canada-based Quinte Health Care hires Gina Johar (Brockville General Hospital) to the newly created position of VP / chief digital officer.

Paige Lisk, MBA (DrFirst) joins Verato in the newly created role of chief people officer.

Huron CEO Jim Roth will resign at the end of the year, replaced by President and COO Mark Hussey, MBA. The healthcare segment of the publicly traded management consulting firm generates 42% of its revenue.

Announcements and Implementations

Google recaps some of its health AI developments and projects in its “The Check Up” event that features Chief Health Officer Karen DeSalvo, MD, MPH, MSc.

• Smartphone screening for diabetic retinopathy.
• Using a smart phone’s microphones to record heart sounds as a basic stethoscope.
• Applying AI to pregnancy ultrasound.
• Upcoming: Google Search will show provider appointment availability and allow booking a visit, starting with CVS MinuteClinic.

The VA launches its second site on Cerner as Walla Walla Health Care goes live.

Other

John Roach, who in the late 1970s turned Tandy-owned Radio Shack – mostly known for selling weird electronic parts and CB radios — into a pioneer of the home computer market as the company’s chairman and CEO, died last week at 83. The home computer industry was arguably born in 1977 with the introduction of the Radio Shack TRS-80 (the TRS stands for Tandy Radio Shack, but the system was widely panned as the “Trash 80”), the Apple II, the Commodore PET, and Digital Research’s CP/M operating system that paved the way for Microsoft’s MS-DOS and 1981’s IBM PC.

A former Vanderbilt University Medical Center nurse is found guilty of criminally negligent homicide for killing a patient by administering the wrong medication. RaDonda Vaught ignored several drug dispensing cabinet warnings and failed to perform basic medication checks in administering the paralyzing drug vecuronium to a 75-year-old patient instead of the ordered sedative Versed before an imaging procedure. A nurse colleague who worked in the same neuro ICU unit said that VUMC’s Epic conversion had caused delays in updating the drug dispensing cabinet information, forcing hospital administration to tell nurses to perform system overrides to obtain patient meds. The imaging area did not have a barcode scanner to verify the drug chosen. A nurse advocate says that medication errors are common and can be made by anyone, adding that a jury of Vaught’s peers would have been ICU nurses. Experts question whether VUMC’s systems and processes were at least partly to blame and ponder the potentially negative impact on error reporting of holding medical professionals criminally responsible for making mistakes. VUMC was not penalized even though it did not report the error as required by law and paid a settlement to the patient’s family that barred them from commenting public on the incident, which was revealed months later in an anonymous tip to CMS. VUMC also told the medical examiner that the patient died of natural causes.

Saint Francis Hospital (CT) stages a “clap out” for the departing team of 20 US Air Force personnel who completed a 30-day FEMA assignment to help with the COVID-19 surge. The hospital offered a similar welcome when the service members arrived in February.

Sponsor Updates

• OptimizeRx will present during the virtual RWE Symposium April 11-12.
• Olive teams up with Akava through its Deploy Partnership Program to accelerate the delivery of cybernetic solutions to the healthcare market.
• PatientBond helps national PBM WellDyne boost member engagement to achieve increases in text message engagement, actions taken on text-based refill reminders, and medication adherence.
• Pivot Point Consulting publishes a new case study highlighting how long-time customer Indiana Hemophilia & Thrombosis Center has found strategic and operational value in interim CIO services.
• PerfectServe accelerates speed to care with faster delivery of critical lab results.
• Curation Health Chief Medical Officer Matt Lambert, MD writes a Physicians Practice article titled “No doctor is an island.”
• Spok has reduced the size of its board to six members to better align its size and composition with the company’s recently announced business strategy.
• Talkdesk introduces new mobile apps to its On-the-Go suite of contact center solutions.

Blog Posts

• 5 Tips to Increase Patient Engagement Through Personalization (PatientBond)
• Quality Measurement 101: Risk Adjustment Isn’t Risky Business (Premier)
• Preventive Compliance Monitoring: Why It Matters (Protenus)
• Key Takeaways from Rise National 2022 (RCxRules)
• Evolving Prescribing Practices and Payer Coverage Throughout the COVID-19 Pandemic (RxRevu)
• Addressing the Burnout Challenge in Healthcare (About Healthcare)
• 4 ways interactive technology can help anxious parents (Sonifi Health)
• Affordable Medication and Adherence: Two Sides of the Same Coin (Surescripts)
• 3 key takeaways from ViVE 2022 (Talkdesk)
• HIMSS22: Connection, Equity, and The Patient Experience (TigerConnect)
• Healthcare Workplace Violence. Staffing Pressures. We Have Solutions. (Vocera)
• How to Tell if a Clinical Case Study is Bogus (WebPT)
• Like Everyone Else, Seniors are Texting (Well Health)
• One Year into Hybrid Work, the Digital and Talent Imperatives are Clear (West Monroe)
• SNOMED CT: Why It Matters to You (Wolters Kluwer Health)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 3/25/22

VA officials ‘looking forward’ to launch of new medical record system in Walla Walla despite problems in Spokane

As the agency faces continued criticism for its initial Cerner roll-out in Washington, VA Deputy Secretary Donald Remy says the agency is ready to launch a new Cerner system at its medical center in Walla Walla, WA this weekend.

Osso VR nets $66 million for surgical training

Virtual reality-based surgical training and assessment company Osso VR raises $66 million in a Series C funding round, bringing its total raised to $109 million.

Kaiser Permanente runs $1.5bn PE secondary sale as it looks to expand strategy

Kaiser Permanente is reportedly selling its $1.5 billion stake in several private equity funds, which includes investments in Ginger.io, Ingenious Med, Nordic, Rock Health, and Validic.

News 3/25/22

Top News

VA Deputy Secretary Donald Remy says the agency is ready to launch a new Cerner system at the VA medical center in Walla Walla, WA this weekend.

Several lawmakers have called for a halt to future deployments after the VA OIG issued several reports citing patient safety issues at the initial go-live site in Spokane, WA.

Reader Comments

From Killer Clown: “Re: ViVE and HIMSS. I attended both. I had more fun at ViVe and more meetings at HIMSS. In general, HIMSS was more valuable to my revenue stream. ViVE was for socializing. Relationship building was had at both and a necessity to business.”

From Canasta Disasta: “Re: [vendor name omitted]. Executive [name omitted] was arrested in Miami during ViVE for battery. Drunk, uncooperative, and no motive upon arrest.” I’ve removed identifying information since I don’t usually report on job-unrelated arrests of individuals who haven’t yet been convicted and whose details are skimpy or unconfirmed. The executive bonded out for $1,500 after pleading not guilty. His battery misdemeanor trial is set for April 14.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor CareMesh in Reston, VA. CareMesh is a healthcare communications platform that connects the care continuum so that any provider working with any electronic health record can instantly communicate and collaborate with any other. CareMesh cloud-based services allow hospitals and health systems, public health agencies, physician groups, and others to communicate about patients, maintain complete control over when and where information is shared, and rapidly reduce reliance on outdated tools such as fax and phone calls. Thanks to CareMesh for supporting HIStalk.

I found this recent YouTube video that shows how CareMesh Navigate works within a clinical program or specialty group to manage inbound referrals, monitor patients through treatment, and provide regular updates to referring providers.

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

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

Acquisitions, Funding, Business, and Stock

Virtual reality-based surgical training and assessment company Osso VR raises $66 million in a Series C funding round, bringing its total raised to $109 million.

Kaiser Permanente is reportedly selling its $1.5 billion stake in several private equity funds, which includes investments in Ginger.io, Ingenious Med, Nordic, Rock Health, and Validic.

Sales

• Mount Sinai Health System (NY) selects post-quantum cryptography technology from Sandbox AQ to enhance its cybersecurity.

People

Nordic Consulting names Shae Crawford (Berkeley Research Group) SVP and head of HR.

Cota promotes Miruna Sasu, PhD, MBA to president and CEO.

Summer Brown (Feedtrail) joins Cipher Health as chief customer officer.

Centene hires its vice chair Sarah London, MBA as CEO. She previously served as the company’s SVP of technology innovation and modernization and held roles in Optum that included oversight of its data and analytics solutions as former VP of Optum-acquired Humedica. She replaces Michael Neidorff, who is retiring after taking medical leave.

Michael Donovan (ROI Healthcare Solutions) rejoins Helix Health Solutions as CEO.

Announcements and Implementations

The non-profit EHealth Exchange will award up to $550,000 in grants and other incentives to organizations that are pursuing innovative ways to increase exchange of electronic health information or establish new technical advancements in connectivity.

MercyOne pilots patient-provider matching software from PatientBond. The Iowa-based health system will roll the software out to all of its facilities later this month.

Government and Politics

Bayne-Jones Army Community Hospital at Fort Polk (LA) goes live on Cerner as part of the DoD’s Wave Hood MHS Genesis deployment. Col. Aristotle Vaseliades, hospital commander, said the information management department did an amazing job, rolling out nearly 3,000 pieces of equipment, conducting 176 training sessions, and running countless miles of computer cable. He didn’t mention which department handled embroidering MHS Genesis baby onesies.

The VA awards General Dynamics Information Technology a $45 million contract to support its business and IT modernization initiatives, including integrating new cybersecurity technologies, and ensuring connected devices and telehealth services are protected. The VA is also using GDIT’s cloud-based, AI-powered image classifier, which provides real-time assessments of potentially cancerous skin lesions.

Other

The annual patient payments report from InstaMed – acquired by JP Morgan for $500 million in mid-2019 – finds that 87% of consumers were surprised by a medical bill in 2021 even as providers show little interest in price transparency; 70% of people are sent medical bills by mail even though nearly none of them prefer paying by check; and 74% of millennials say they would change providers to gain a better payment experience.

HIMSS says that total HIMSS22 attendance – combining in-person and digital – was nearly 29,000 and 1,000 exhibitors were present in the hall. My perception on the ground was that HIMSS22 was pretty much back to normal with a slight scaling back that I was not unhappy about. Interest in the digital version seemed modest at best, even though HIMSS sent (to me, anyway) a last-minute code for anyone to register for free.

Sponsor Updates

• Everbridge Senior Engagement Manager Radu Cioata has collected and delivered five vans’ worth of goods to Ukrainian refugees.
• Medicomp Systems releases a new episode of its Tell Me Where It Hurts Podcast featuring Janae Sharp of The Sharp Index.
• EVisit will increase access to telehealth services in underserved communities using cloud computing credits from the AWS global health equity program.
• First Databank opens up its new Vela e-prescribing network to veterinarians.
• Healthcare Growth Partners advises employee wellbeing software vendor MoveSpring in its sale to Reward Gateway.
• Healthcare IT Leaders congratulates customer Kootenai Health on its Epic go-live.
• Meditech discusses FHIR and the future of interoperability on CommonWell TV.
• NextGate adds Verify to its EMPI tool, giving patients the ability to review records and flag inaccuracies.
• The St. Louis County Department of Public Health in Missouri expands its use of Bamboo Health’s technologies and services to include delivery of ifs PDMP.

Blog Posts

• How will rising inflation affect the healthcare revenue cycle? (Experian Health)
• Return to Growth: Patient Activation (Get Well)
• Stepping Up Security of Sensitive Data: 3 Questions Health IT Leaders Should Consider (Healthcare Triangle)
• Enterprise Data Warehouse Implementation: A Cybernetic-Boydian Approach (Health Data Movers)
• 3 Strategies for Sourcing Patient Health Education (Healthwise)
• The Designated Record Set (DRS): Straightforward Questions & Answers (Impact Advisors)
• Filling in gaps in the medical problem list (Intelligent Medical Objects)
• Loyal’s partnership with UCLA Health Brings Answers and Reassurance to Los Angeles Community (Loyal Health)
• HIMSS22 kicks off with KLAS celebration, merger news, and good ol’ fashioned facetime with friends (Lyniate)
• Support ISMP’s Newest Medication Best Practices with MedAware (MedAware)
• Reducing Medical Errors with Physician-Centric EHR Integrations (Medhost)
• Adapting to the new realities of physician practices (Meditech)
• 10 Physical Therapy Specialties to Amplify Your Career (MWTherapy)
• Unlocking the future of patient care with ambient clinical intelligence (Nuance)
• Houston, we have a data problem (Nordic)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 3/24/22

I’m still recovering from HIMSS22. Between the Daylight Saving Time change and a couple of weeks of hopping across time zones, my sleep has been disrupted for days. After experiencing the new normal of conferences, I wonder what healthcare IT marketing budgets will look like in 2023 and beyond.

A recent Medical Marketing and Media article notes that medical marketing budgets increased by 15% in 2021, although they were still below pre-COVID levels. The data was drawn from pharma, biotech, and medical device companies. It looks like money is being funneled to digital channels as opposed to personal promotion. Those strategies include paid digital advertising, content marketing, social media, websites, and microsites. Physicians should be happy that paid traditional TV advertisements have dipped to around 5% of marketing budgets overall and more than half of respondents aren’t using any paid traditional media, such as TV, print, or radio.

Roughly half of the companies’ marketing budgets were being directed to engage healthcare professionals. While 46% of marketers trying to reach professionals used meetings or events in 2020, this dropped to 40% in 2021. Nearly 37% of respondents said they decreased their meetings and events budgets, and fully a third said they spent nothing on that channel. Those surveyed were positive on using social media to reach healthcare professionals, with 39% increasing their paid social media budgets. Consumer-focused marketing represented 31% of expenditures, with more than half of companies relying on social media.

Speaking of marketing: Anthem plans to change its name and rebrand to Elevance Health. The company says the new name will represent the non-insurance services it offers, including digital health, pharmacy, complex care, behavioral health, and more. It also notes that the new name highlights its “commitment to elevating whole health and advancing health beyond healthcare.”

I’m not a big fan of smashing words together to try to come up with something new, especially since using either word – elevate or advance – doesn’t really say anything about what the company stands for. Fortunately for consumers who are often confused by these rebranding efforts, the names of the Blue Cross Blue Shield health plans it owns will not be changing. Shareholders have to approve the name change at their May meeting, and if I had to vote, I’d want to know how much the rebranding effort will cost and what the company believes the return on the investment will be. Even if the ROI isn’t good, it will still stimulate the economy through countless print orders, website design efforts, and creation of promotional items. As a healthcare consumer, I’d rather see payers spend money on reducing administrative burden and compensating care providers fairly versus buying a bunch of new travel mugs and business cards.

I do a lot of consulting around patient engagement and getting patients to do many pre-visit tasks electronically prior to appointments. There’s always pushback from individuals who feel that patient questionnaires are too long and that they’re not worthwhile. A recent study in JAMA Network Open shows that patients prefer sharing sensitive information electronically rather than in face-to-face encounters. Disclosure of domestic violence, depression, and other conditions was twice as likely when inquiry happened in a tablet-based app compared to questions from a person. The app used in the study was integrated with the EHR, allowing clinicians to better follow up on positive responses to screening questions.

Hopefully this will help solution designers understand that pre-visit gathering can be useful rather than an annoyance to patients. I think more patients would be apt to participate with pre-visit questions if two things happened. First, patients deserve a better explanation of why the provider needs the information and how it can improve quality of care. Second, providers have to actually use the information the patient already provided and make it clear that they’ve reviewed it and might have a couple of follow up questions, rather than just proceeding on autopilot like they may have done for years.

I was interested to read about Amwell making its telehealth platform available through LG’s healthcare platform. It made me instantly think of a Jetsons-like interaction where one could be standing in front of their smart refrigerator having a healthcare visit. On the flip side, integration with smart appliances might be invasive, especially if my healthcare provider can get information on how often I restock the vodka in my refrigerator or how many vegetables are in the crisper drawer. No release date was available, which means either it’s still early in development or they’re just playing coy. If it’s the former and they’re looking for provider and patient opinions, I might know someone who’s interested.

I ran across this article while flying last week. Payers are apparently shelling out $979 million in excess healthcare expenditure due to turnover in the primary care physician ranks. The underlying study estimates that for each primary care physician who leaves practice, there is $86,336 in additional spending the following year. This may be due to patients going to the emergency department because their primary physician left or choosing more expensive specialists to manage problems that could be handled by primary physicians. More than a quarter of the spending was linked to burnout-related turnover.

From Jimmy the Greek: “Re: buzzword bingo. Check out this word salad masterpiece found in a Gartner report.” Gartner says:

Hyperautomation initiatives focus on ensuring that businesses and IT process workflows are as frictionless as possible. This task-level digitization is the foundation for process-level and cross-functional enablement of decision making for business agility and resiliency. Well-architected hyperautomation initiatives demand standardization of processes, which enables improved quality and cycle time. Additionally, digitalization enables accessibility and transparency, which catalyze both human and digital workers.

I’m still trying to wrap my brain around the idea of how one catalyzes a nonhuman worker. For those of us who were educated at a time when the art of diagramming sentence structures was still taught, this paragraph is a masterpiece. Thanks for sharing and for a bit of distraction during a busy day full of conference calls.

What’s the most obtuse thing you’ve read this week? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/24/22

Eko expands algorithmic heart problem detection and lands $30M Series C extension

Digital stethoscope company Eko adds $30 million to its $65 million Series C funding round, and announces the launch of clinical decision support software.

Qualifacts + Credible Announces New Company Name

After merging in 2020, EHR vendor Qualifacts + Credible rebrands to Qualifacts.

PursueCare’s Virtual Addiction Treatment Program Adds In-Person Clinics, Continuing Rapid Expansion

Virtual behavioral healthcare provider PursueCare opens its first in-person clinic as part of a service expansion to Pennsylvania and New Jersey.

Morning Headlines 3/23/22

Antidote Health Raises $22 Million in Series A Funding

Membership-based telemedicine company Antidote Health will use a new $22 million investment to add primary and chronic care services, and to further develop AI screening and clinical decision support system capabilities.

Recora Announces $20M in Series A Funding and Unveils Cardiac Recovery Program for Health Systems, Medical Groups and Health Plans

Tech-enabled cardiac recovery startup Recora raises $20 million in Series A funding.

VA and Cerner to investigate cause of Spokane electronic health records outage

The VA and Cerner promise to perform a thorough root-cause analysis of the software bug that caused Mann-Grandstaff VA Medical Center to take its Cerner EHR offline earlier this month.

U.S. Supreme Court rejects Epic Systems’ bid to restore $280 mln jury award

The US Supreme Court will not take up Epic’s challenge to an appeals court’s decision to cut the amount of damages it won in its stolen trade secrets case against Tata Consultancy Services.

News 3/23/22

Top News

Madison, WI-based DeliverHealth acquires PresidioHealth, which offers automated coding and revenue workflow capabilities for physician groups, urgent care centers, and freestanding ERs.

PresidioHealth founder and President Douglas Evans, MD CTO Tom Gregory, and VP of Client Success Carlie Richard will join DeliverHealth’s executive team.

The company’s last acquisition was in late 2020, when it purchased Nuance’s HIM and EHR go-live services businesses. DeliverHealth CEO Michael Clark, MBA was previously SVP/GM of Nuance’s provider solutions.

Reader Comments

From: ROI Healthcare Solutions. “Re: Changes in leadership. We’re continuing to experience tremendous growth both within the US and internationally and are excited for our future and our ability to better serve our customers. The ROI team has increased from a staff of 12 people in 2014 to over 160 today. With growth comes change, and change can be challenging. The leadership changes that have happened at ROI have taken place over time. Some were voluntary departures, while others were strategic and forward-looking. We are forever grateful for the contributions of each of these individuals. They each helped bring us to where we are today with a solid foundation upon which to grow.”

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

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

Acquisitions, Funding, Business, and Stock

TimeDoc Health raises $48.5 million in a Series B funding round led by Aldrich Capital Partners. The company, which has raised nearly $60 million, specializes in helping primary care physicians virtually manage the care of their patients between office visits.

Cardiac recovery startup Recora raises $20 million in Series A funding. The New York City-based company offers cardiac rehab programs to health systems and payers that incorporate virtual care, remote patient monitoring, and dedicated care teams. Co-founder Abhi Chandra’s previous venture was Spring Health, where he and his two other Recora co-founders developed a mental healthcare platform for employers.

People

Davis Medical Center (WV) physician James Gainer, MD takes on the additional role of CMIO at Davis Health System.

Sansum Clinic (CA) promotes Sean Johnson, RN to CIO.

Summer Brown (Feedtrail) joins CipherHealth as chief customer officer.

Announcements and Implementations

Rush Health (IL) has implemented Arcadia’s population health management software across its four hospitals and 140 practices.

Heritage Valley Health System (PA) leverages Bluestream Health’s virtual care integration capabilities to offers its patients a more seamless digital experience.

Hicuity Health announces GA of standalone virtual nursing services.

Government and Politics

The US Supreme Court will not take up Epic’s challenge to an appeals court’s decision to cut the amount of damages it won in its stolen trade secrets case against Tata Consultancy Services back in 2017. A judge had initially awarded the company $940 million in damages, but that figure was later deemed unconstitutionally high and slashed to $420 million.

The VA and Cerner promise to perform a thorough root-cause analysis of the software bug that caused Mann-Grandstaff VA Medical Center and associated clinics in Washington and Idaho to take their Cerner EHR offline and revert to paper records earlier this month. The troubled roll-out of the new system at Mann-Grandstaff, the VA’s initial go-live site in its projected $16 billion facility-wide Cerner implementation, has prompted several lawmakers to call for the postponement of future implementations.

Carl R. Darnall Army Medical Center (TX) at Fort Hood, the 71st Medical Group at Vance Air Force Base (OK), and Womack Army Medical Center (NC) at Fort Bragg have gone live on Cerner as part of the DoD’s MHS Genesis EHR overhaul. The new system will be deployed in several more waves this year to 54 facilities, the DoD’s largest group in any calendar year.

Other

The trial of a former Vanderbilt University Medical Center nurse accused of reckless homicide and impaired adult abuse begins this week. The charges stem from a medical error in which she injected an elderly patient with the paralyzing agent vecuronium (Norcuron) instead of the ordered sedative midazolam (Versed), which was intended to to overcome the patient’s claustrophobia before having a PET scan. As I mentioned when she was first charged, the nurse withdrew the wrong medication from the automated dispensing cabinet after typing in the letters VE for versed, then after not finding the drug’s name, overrode the system to gain access to the vecuronium. The patient was left alone in the scanner for up to 30 minutes where she experienced cardiac arrest and brain death, then died the next day after life support was turned off. In testifying before the nursing board last year, the nurse said that Vanderbilt encouraged overrides when necessary to overcome cabinet delays and constant technical problems caused by the system-wide transition to Epic.

Sponsor Updates

• NTT Data Research publishes a new report, “Innovation Index: Digital Strategies for an Era of Constant Disruption.”
• AdvancedMD recognizes Channel Marketing Manager Carri Hamilton with a FIT Award.
• AGS Health exhibits at the OHIMA 2022 Annual Meeting & Trade Show in Columbus, OH through March 23.
• Ascom welcomes David Gutillo (Spok) as senior key accounts manager.
• Availity partners with Vim to connect payer data to clinical workflows at the point of care.
• Azara Healthcare earns ONC-Health IT 2015 Edition Certification from the Drummond Group.
• Baker Tilly releases a new edition of its Healthy Outcomes Podcast, “The value of cybersecurity in the healthcare industries.”
• Bamboo Health publishes a new case study, “How the Mass League is Increasing Interoperability & Coordinating Care with Pings.”
• Cerner congratulates customer Intermountain on achieving HIMSS Stage 7 status for the third time.
• Optimum Healthcare IT announces that Red Lake Nation College has joined its CareerPath health IT apprenticeship program.
• CHIME will host a Clinical Informatics Leadership Boot Camp May 15-18 in Salt Lake City.
• CMS certifies Netsmart’s electronic visit verification system as the state solution in Georgia.

Blog Posts

• Agfa HealthCare recognized as Cybersecurity Transparent Leader (Agfa HealthCare)
• Drive Patient Volume Through Always-On Automation (Actium Health)
• The digital transformation of colonoscopy prep (Bravado Health)
• Patient Monitoring vs. Clinical Surveillance: There are Differences (Philips Capsule)
• Four Ways to Support Patient Safety Through Healthcare Technology and Communication (CereCore)
• Poised for Growth: How Digital Health Companies Can Meet Cybersecurity and HIPAA Compliance Expectations (Clearwater)
• HIMSS22: A snapshot into the brave new world of health information and technology (ConnectiveRx)
• How One Nurse Rediscovered Her Passion Within Hospital at Home (Current Health)
• Here’s What We’ve Discovered About Clinical Data After Studying It for the Last 10 Years (Diameter Health)
• Top Cybersecurity Investments for Healthcare in 2022 (Dimensional Insight)
• The First Step: Patient-Centered Medical Home (EClinicalWorks)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 3/22/22

Fresenius Medical Creates Kidney-Care Business With InterWell, Cricket

Fresenius Medical Care will create a kidney-care business valued at $2.4 billion by combining its US business with InterWell Health’s providers and Cricket Health’s technology.

DeliverHealth Acquires PresidioHealth, Expanding its Software Platform to Speed Up Appropriate Reimbursement

Health IT vendor DeliverHealth acquires PresidioHealth, which offers automated coding and revenue workflow capabilities for physician groups, urgent care centers, and freestanding ERs.

TimeDoc clocks in $48 million

Virtual care management company TimeDoc Health raises $48.5 million in a Series B funding round led by Aldrich Capital Partners.

HIStalk Interviews Christopher Molaro, CEO, NeuroFlow

Chris Molaro, MBA is co-founder and CEO of NeuroFlow of Philadelphia, PA.

Tell me about yourself and the company.

I come from healthcare as a patient, first and foremost. I am an Army veteran, a West Point graduate, and went to the Wharton School for an MBA. I met a psychiatry professor there and that’s where NeuroFlow got its start. NeuroFlow is a digital health platform that helps assess and triage a population of behavioral health conditions in non-behavioral health settings, like primary care, and helps patients get to the right level of care, keeping them engaged and measuring outcomes over time.

You were deployed to Iraq as a platoon leader in combat. What is your experience with the military’s system for behavioral care?

A lot of people are probably intimidated about the military, or the government healthcare system, because of lack of knowledge or experience with it. In reality, it’s just a giant integrated delivery network, a giant at-risk payer-provider system. It’s obviously the biggest in terms of resources and so forth. When I was serving from 2006 to 2015, there was a tremendous amount of resources and investment, in particular on the mental health side. We were a number of years into the conflicts in Afghanistan and Iraq. PTSD was well known and it was discussed and talked about. There wasn’t a shortage of investments and resources or the supply of those resources.

The challenge is similar to what you see in the non-government space, which is identifying those issues, getting people with those issues engaged, providing them access, and offering them ongoing support at the right time and at the right place. It’s a challenge, especially because of the stigma that is associated with the mental health space. People are, for whatever reason, ashamed, embarrassed, and maybe concerned about their job security or their ability to succeed professionally, so there was a reluctance to get that care. That was a challenge in the military, but from my NeuroFlow perspective in  working with a lot of commercial partners, we see that same thing transcend into the civilian population.

How can technology help bridge the chasm between physical and mental well-being, which involves different providers and insurance requirements?

In the world today, 40 to 50 million people a year have a behavioral health issue. Looking at claims data, we know that two-thirds of them will never get it treated. That’s a huge problem. Imagine if we said that two-thirds of people with cancer never get it treated. That would be a tragedy. That same thing is happening in mental health today.

The highest prescribers of antidepressants in the country are PCPs. They don’t have that nuanced understanding about where to send someone. Maybe psychiatrists have a long wait time, which is true across the country, so PCPs fill that gap. The problem is that no one ever follows up. There’s no continuity of care.

The good news is that there’s a ton of integrated care models, specifically the psychiatric collaborative care model, whose outcomes and significance has been proven through 80 or more randomized controlled trials. The challenge is that it’s incredibly difficult to scale and it’s incredibly expensive. You hire psychiatrists, you train them, and you integrate them with PCPs or other providers like OB-GYNs and pain management doctors. It adds to the work and the workflow.

That’s where we think technology can help. Technology can help automate a lot of the workflow that is required for collaborative care, allowing the providers to operate at the top of their licensure. You can reach more people without needing more resources, scaling something that historically only the best-funded academic medical centers could do. Now you can make it more accessible throughout the healthcare system.

How does the psychiatric collaborative care model work in real life?

A lot of people will say they do integrative care or co-located care. They physically embed a social worker, psychologist, or psychiatrist with the primary care provider. That’s a great first step, but according to the academic model that was first studied and researched at University of Washington, that is not the collaborative care model. 

The collaborative care model is a triangular, team-based approach, where a behavioral healthcare manager works hand-in-hand with a primary care provider, or other medical provider, to help identify patients who have mild or moderate behavioral health issues. Then if appropriate, they keep them in the primary care clinic instead of referring them out. They refer them if they are higher risk or if they need a higher level of care, but then there’s a psychiatric consultant there to help guide the PCP in how and what to prescribe.

This removes the burden placed on the dedicated behavioral health providers who are already in short supply. It gets the highest-risk patients to the dedicated behavioral health providers while keeping the lower-risk people treated within the medical provider, the PCP or otherwise. It’s a better allocation of resources and better continuity of care.

Does the traditional model create a blind spot for PCPs who refer patients who don’t follow up, leaving the PCP unaware that behavioral care never happened and leaving no electronic trace in claims data?

In a lost referral, I’m a PCP, I refer you to a therapist, and after you leave my office, I have no idea if you followed up, if you’re getting the care that you need, and how that’s impacting your other chronic conditions. Think about someone who has hypertension or diabetes. Most of those people have a co-occurring behavioral health issue. They are four times more expensive on an annual basis – they are higher healthcare system utilizers or have higher prescription spend than someone with just the chronic medical condition. 

The collaborative care model tries to close that loop. Without technology, that’s a very manual process. I have to call everyone who is enrolled in the model and do monthly follow-up and assessments. It gets burdensome and time-consuming. Technology allows you to do that in a more automated fashion so that those resources connect over voice or in person only with the people who need that higher level of touch.

Employers bear some of the cost of behavioral health issues in the form of abseentism and lost productivity. Does the market address those people, who are probably insured and may receive behavioral health benefits, from others whose needs are similar but who don’t receive employer or insurer support?

That’s precisely it. If there’s a silver lining of the last two years in the pandemic, it’s that as a society, there’s a light that is shining on this mental health conversation. More than ever, people are acknowledging that there are challenges here. We have all felt them at home, and we’ve seen that in the workplace now. The ability to have this more integrated care model not only helps the cost of care, it improves the outcomes. The interesting thing is that we measure not only improved mental health outcomes, like a decrease in depression or anxiety, but you also see improved A1C levels, pain levels, and outcomes on the physical health side.

On the employer side, NeuroFlow does work, some of which is public, with groups like Aflac and Prudential to support their short-term and long-term disability business. That’s relevant because even if people aren’t in disability for mental health reasons, the mental health aspect of being lonely, away from your work, depressed, or recovering has a huge impact on their productivity and getting them back to work. We help their disability claimants and beneficiaries get better faster with the integrated care model.

Behavioral health is the one inarguable success story of telehealth, where both patient preference and outcomes have been documented as well served. How does telehealth fit into the model you described?

It’s great. It’s the best thing that could have happened in the behavioral health space. It is removing those barriers of adoption, engagement, and access. However, it doesn’t fix the problem that a tele-therapist is still a finite resource. If I’m providing teletherapy, whether it’s over the phone, video, or in-person, I still can only see one patient at a time. I’m still a limited resource.

There’s still the question of getting the right people to the right level of care. Not everybody needs a tele-therapist. Some people would benefit from digital self-service tools alone, working on mindfulness and exercises. It’s still a matter of triaging effectively. 

Telehealth services also don’t help with the identification of these issues in primary care or in other types of settings. While telehealth is an enormous step in the right direction, in terms of improving access and so forth, there’s still a huge component that it doesn’t address, which is the way that we think about behavioral health from a behavioral health integration lens as opposed to just the services.

What developments do you expect to be most important to the company and your niche in the next few years?

For the company, we think of ourselves as an augmentee to the providers. We are a clinical decision support engine, and to use a military term, we are a force multiplier to the system. We’re not competing with the therapy companies. Quite the contrary, we are helping get the right people to them. We’re investing a lot into open API structures, making interoperability easier with appointments and making that user experience more seamless from primary care to therapists and back to primary care. I think that will be a huge trend as we move forward in the industry.

In terms of the industry overall, the jury isn’t even out any more. The data is unequivocal that the impact of physical and mental health combined is astounding. I think you’ll see more value-based care contracts that are aligning the payers and the providers to provide holistic care to the patient, ultimately getting the patient better on both sides of the spectrum and making sure that we are reducing unnecessary utilization and improving costs, which I’m excited about.

Readers Write: What We Can Learn from Nurse Mobility

What We Can Learn from Nurse Mobility
By Richard Watson, MD

Richard Watson, MD is the co-founder of Motient of Greenwood Village, CO.

I’ve always been envious of our nursing credentialing and licensing system. I’m not easily given to professional jealousy, but over the years, I’ve worked through the process of becoming credentialed in three states and six hospitals. The mere thought of the effort required is enough to dissuade one from changing locales. Nurses, however, have compact licensing agreements, and a good two-thirds of the states accept licensing across state lines. This is a great idea, and it’s long overdue for the physician credentialing process.

When I applied for licensure in Alaska, I was warned about the protracted time frame. I had long dreamed of working in the remote areas of the state, and I assumed that since the need for healthcare access was significant, the credentialing process would be easy. Au contraire, my friend! Evidently, there is a whole cohort of medical professionals with difficult pasts who expect Alaska will be an easy reentry point into the profession. In any case, the length of time between communications led to an almost nine-month process. In the mean time, my nursing colleagues were freely moving and working from state to state.

During the nascent stages of COVID, nurse mobility became an absolute necessity. While the news reported on the explosion of coastal cases, the rest of the country remained almost free of contagion, yet people were deeply hesitant to seek urgent and emergent care. Emergency room and EMS volumes plummeted, and hospitals experienced record low capacity.

Because of the great disparity in COVID prevalence, hospitals on the coasts were struggling with staffing crises, while most other states were laying off staff. Compact licensing agreements allowed nurses to step in to fill urgent needs in the system. The number of travel nurses expanded rapidly, rising by 40% in 2021. As cases spread nationwide, the need for staff became much more uniform. Now, with nursing attrition rates at an all-time high and nursing staffing levels at an all-time low, agency nursing has moved into position as the primary broker of nursing resources.

To add fuel to the fire, the massive influx of COVID relief funds has only multiplied the problem. Nurses are readily being poached from one state to another—and often back to locations closer to their home base—at several times their original salary. No one could fault nurses for capitalizing on this unique circumstance, and there is a longstanding, valid argument that nursing salaries have lagged far behind even salaries for medical professionals who have no patient contact whatsoever. But where is this really headed?

Surely hospitals are doing the math, calculating the percentage of agency nurses they’re using versus their incoming revenues for floor and ICU beds; presumably, they’re tracking how the influx of agency nursing is impacting overall costs and revenues. Or maybe not. In this artificial world of COVID dollars, where the gates are open and entry is relatively easy, the actual fallout of these short-term relief programs is poorly calculated.

Agency nursing is set to expand by another 40% in 2022. Some healthcare organizations have called for the FTC to examine these practices and policies, but the rate of expansion far outstrips the analysis. Some have called for a moratorium on agency nursing, as well as for a centralized staffing commission and other bureaucratic solutions. But honestly, once the COVID dollars are closed, the revenue incentives for the high staffing costs will be gone. To my mind, three points stand out in this quagmire:

• Nurses are one of the most important components of our healthcare system. Without a doubt, nurses are those in closest proximity to patients experiencing a health crisis. We must provide them with an environment that fosters the genuine compassion and agile intelligence we will all need at our bedside at some point.
• We must begin to understand that every problem in healthcare—from the minor to the pandemic-sized—doesn’t necessarily benefit from sweeping edicts and centralized solutions. The COVID story is rife with examples of unintended consequences.
• Our government agencies must stop throwing money at everything that seems difficult in healthcare. Shoring up a dysfunctional system with an influx of ready cash just solidifies that dysfunction. The difficulty of a strong central regulatory system is the lack of knowledge about what constitutes real solutions at a regional level.

We are rapidly moving toward the time where we will need to rebuild a healthcare system that is begging for renovation. Much of what is good about our healthcare is the direct result of the nurses and other frontline professionals who compassionately care for others. We need to take advantage of these seminal moments to strip away the obstacles for those who are doing that irreplaceable work, so that it becomes easier for them to follow their calling within a sustainable system.

Morning Headlines 3/21/22

Murray, McMorris Rodgers demand VA stop computer system launch in Walla Walla after reports reveal problems persist at Spokane hospital

Senator Patty Murray (D-WA) demands that the VA delay its planned March 26 Cerner go-live at the Walla Walla VA following VA OIG reports of continuing problems at the first live site at Mann-Grandstaff VA Medical Center in Spokane.

Healthcare tech platform Doctolib reaches $6.4 billion valuation

France-based Doctolib — which offers doctor search, scheduling, virtual visit booking, and document sharing — becomes the country’s highest-valued startup at $6 billion based on a new funding round.

Canopy Launches Out of Stealth With $13 Million to Help Oncology Practices Adopt a Proactive Care Delivery Model

Canopy (formerly Expain Health) launches its EHR-integrated technologies for oncology practices alongside securing a $13 million funding round.