Katie the Intern 4/2/21

Hi, HIStalk! Long time, no write. Things have been really busy, but I am still making time to write some columns here and there. 

This week’s column focuses on B.well Connected Health, a healthcare technology company that provides a platform for healthcare consumers to stay connected to their providers and their data in a digital, personalized health experience. I spoke with CEO Kristen Valdes, who founded B.well in 2016 as “a way to transform the way consumers interact with the healthcare delivery system by giving them access to all of their health data in one place.”

Valdes has been an executive in the healthcare field for over 20 years, working in digital health and helping to start one of the first private Medicare Advantage plans in the country. When her daughter began facing an undiagnosed medical issue, she began to see holes in the healthcare information delivery system and felt that she could create a business to fill those needs. 

“When my own child was born with a very significant autoimmune condition, here I was, this healthcare industry expert, and I could not navigate the system on behalf of my daughter,” she said. “She had a near-fatal incident because two EMRs couldn’t communicate with one another.”

It took seven years to get her daughter properly diagnosed, and seeing the failures in the communication of healthcare systems drove Valdes to create a technology company that could mend the breaks. B.well was founded as a system to allow users to have access to their in-person, digital, and virtual care at all times and to share that information with whomever they want. 

“We are a B2B business. We sell into health systems, insurance companies, and pharmacies as a way to aid them in their digital transformation towards the consumerization of health,” Valdes said. “B.well finds a way to connect services that businesses offer into consumer lives, even though 99% of the time, they are outside of the doctor’s office.”

Consumers need to navigate their medical needs and B.well wanted to make it easy for users to have access to all their data, records, appointments, recommendations, and more, all in one place, Valdes said. Though it is not an EHR, B.well is bi-directionally integrated with EHRs.

The process of creating a delivery system started with many questions, including how such a system could get access to healthcare data and give it back to users. “You cannot engage someone in a personalized way if you don’t know anything about them,”  Valdes said. “Data is critical to the consumer.”

Valdes had to make sure that the technology would not impact an EHR’s flow. The integration of B.well is there to connect consumers to their records and information. Regulations were put into place with technology standards that allowed open API interfaces, an important piece to the puzzle. Open API interfaces unlock the ability to push and pull information seamlessly between systems, Valdes said. 

The B.well team did surveys and analyses to see where the user pain points in healthcare data are, creating a basic features list based on the results. Users wanted a simple, affordable system that allows quick and easy access to providers and simple directions for when they need to do something. 

“We started with consumers first and architected what they would want to see out of the healthcare system. Then we reverse engineered that into the data holders and stakeholders of healthcare where all the information as mapped that would be needed to pull together,” Valdes said. “That’s where we determined that a net-neutral platform for consumers was possible.”

B.well also helps providers move their focus into population health as they adjust from fee-for-service models to value-based care. When physicians can see data in real time and track which patients are going to appointments and filling medication accurately, they are able to see their results and adjust care based on outcomes. 

“Because we connect consumers to their data with their consent, we also empower them to share that data back to their provider if they choose,” Valdes said. “Healthcare providers have not historically had the visibility to that information, nor have they had the ability to see the interactions with the healthcare system that happens outside of their own offices. As we shift to value-based care is, it’s much easier to help a provider take risk, meaning that they are going to be responsible for someone’s health outcome.” 

Outcomes are important in value-based care, and to get real results, engagement is necessary. B.well sports a 64% engagement rate versus the industry average 17%, meaning that users both engage and take action towards their health by using the B.well technology system. B.well knows that consumers do not want to log in to a health application once a day, but they will respond when messages are relevant. 

“The way that we define engagement is that consumers not only log in to the application, but they actually take an action towards bettering their health,” Valdes said. “Because we have access to a consumer’s data, we only target them with information and nudges at the point of time that it’s appropriate in their care.” 

B.well also recently partnered with Mastercard as a way to enhance the safety of ID verification for B.well’s services. To verify identity and increase the safety of data and information sharing and matching, B.well will use Mastercard’s biometric tech to validate the identity of users. This has already been implemented in B.well’s use of Mastercard through ThedaCare’s Ripple health management tool.

“In-person encounters are not always the first encounter we have in healthcare,” Valdes said. “We partnered with Mastercard to improve digital identity beyond what healthcare offers today.” 

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That’s it for today! I enjoyed learning about a healthcare delivery system that interacts with EMRs and EHRs to better connect users to their healthcare data and information. Thanks for reading! 

Katie The Intern

Email me or connect with me on Twitter.

Katie the Intern 3/12/21

Hi, HIStalk! So sorry it has been a few weeks. I’ve been working on some COVID-19 research pieces, applying for full-time jobs, and working in my other part-time positions. Hope you all are well! 

Today’s column features an interview with Jack Jeng, MD, MBA, chief medical officer at Scanwell Health. He has served in the role for two years and worked in roles managing partnerships, business development, and medical and regulatory affairs. 

Scanwell Health developed an app for users to complete laboratory tests and obtain fast results from home. Tests include UTI and kidney disease detection, but Scanwell Health hopes to soon have COVID-19 antibody and antigen tests available.

“We develop software to allow at-home medical testing to be performed,” Dr. Jeng said. “We take existing tests that have already been developed by manufacturers and we help them adapt it so that now it can be used at home with the help of the Scanwell software.” 

The Scanwell Health app takes a photo of a testing strip (for tests such as the UTI detection test) and runs the image through computer vision algorithms to obtain lab results, Dr. Jeng said. There is little wait time and users obtain results in the privacy and comfort of their home. 

“You don’t have to worry about sending any samples back to a lab or about waiting for results,” Dr. Jeng said. “You get the results pretty much immediately.” 

Scanwell’s software doesn’t just return lab results using this color-metric technology. It also walks users through how to complete at-home lab tests and connects them to health care provider partners. For the UTI test, Scanwell Health connects test takers to Lemonaid if they’d like to see a provider after they receive test results. Responses typically come from providers within two hours of submission.

“Once you get the result, you can choose to complete a telehealth consult by tapping a button in the app that takes you to a telehealth provider,” Dr. Jeng said. “You would answer some questions with their doctors, and if appropriate, the doctor would write you a prescription.” 

So how do these tests work? Users order a test and then a QR code is scanned when ready to use. The Scanwell app loads instructions for that test and explains how a user will perform the collection needed. For the UTI test, the app tells users to collect a urine sample on the provided test strip or “scan card.” The app will then start a timer for the reaction time and tell the user to take a picture of the test strip. 

“It will run a few algorithms to make sure the lighting is standardized, there are no shadows, and the quality of the image is appropriate,” Dr. Jeng said. “If it passes all those checks, it will then look at the change in color on the test strip and give you a result right away.”

The algorithms used by Scanwell software standardize the image taken by the user, Dr. Jeng said. “Ultimately, it is using the smartphone’s camera and our software’s algorithms to give you the result.”

Scanwell Health is partnering with Innovita to develop tech for COVID-19 antibody testing. Scanwell is also partnering with Becton Dickinson for a COVID-19 antigen test. While both of these tests are still in development phases, Scanwell Health is excited about their ability to give users fast results for COVID-19. 

The developing COVID-19 antigen and antibody tests won’t use the color-changing technology used in the UTI tests. These tests will use lateral flow assay testing, Dr. Jeng said, to detect the presence of a particular substance similar to a pregnancy test.

The COVID-19 antibody test should offer results in as little as 15 minutes. This test is performed after a finger prick, which would also be guided by the Scanwell Health app. The collection card will then be photographed by the user. These lab results will eventually be counted for COVID-19 case numbers because they will be documented through lab testing.

“Once the test is available to the public, we’re able to facilitate state and federal public health reporting requirements because we have an app that is the one doing the analyzing of the test strip,” Dr. Jeng said. Scanwell Health will be able to share these results because there is no reliance on users reporting a positive or negative result. 

While these COVID-19 tests are still in their study phase and will need to go through the FDA review process, the technology that Scanwell Health makes for reading these tests has been used for many years. Scanwell Health’s founder and CEO, Stephen Chen, MBA developed the idea from a family business that manufactures in vitro diagnostic tests. 

“He was working at the family business on the next generation of urine analyzers when he came up with the idea of what is now Scanwell,” Dr. Jeng said. Stephen Chen saw the potential that smartphones offered for users to have better access and control of healthcare related testing. Since 2010, Chen worked on the idea of smartphone powered test analyzers and founded Scanwell Health in 2018 after FDA clearance of the UTI test. 

As far as the future of Scanwell Health beyond the developing COVID-19 antibody and antigen tests, Dr. Jeng said that Scanwell hopes to bring this ease-of-access testing to rural areas without close healthcare access. The possibilities for future tests are unlimited, as testing does not have to be limited to infected diseases but can also provide tests for chronic disease testing and monitoring. 

“Our focus is on bringing as many tests into the home as possible because we recognize that more and more people are seeking ways to get care from home,” Dr. Jeng said. “It really enables people to test and get treated on their terms, where they want, when they want.”

Scanwell Health also has a chronic kidney disease test and is working on studies for monitoring kidney disease over time. Scanwell Health received a $1.6 million grant from the NIH for this study with the hopes that it could provide insight into early signs of chronic kidney disease by testing participants once a month.

Dr. Jeng said that Scanwell is exploring options for their tests to be documentation of negative COVID-19 tests in the future. Scanwell Health also has a focus on bringing testing to middle to low-income countries. They work with an organization called Find to develop malaria tests in pilot countries such as Cambodia, Indonesia, Rwanda, and Sudan. Scanwell Health hopes to expand testing so that people all over the world have better access to testing and healthcare technology.

“When we look at lower-income countries, they don’t have the same kind of infrastructure as we do. They don’t have the same number of labs and access to testing, but a lot of them do have smartphones,” Dr. Jeng said. “Our approach, we think, is really universal, and what may be considered convenient in the United States could be the only way to do testing in another country.”

That’s it for this column. Hope you enjoyed! 

Katie The Intern

Email me or connect with me on Twitter.

Katie the Intern 2/12/21

Interview: Rafid Fadul, MD, MBA, executive medical director, Wheel; and director of pulmonary medicine, Blanchard Valley Health System.

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Katie the Intern 1/29/21

Hi, HIStalk! Hope you all are doing well. This column offers a different perspective, but speaks to working with IT and project management, surviving acquisitions, job termination, and how COVID-19 has paved this landscape of change. Hope you enjoy! 

I spoke with Randy Burkert of Asheville, NC. He served until recently as manager of Mission Health’s Center for Innovation in Asheville. His early career was in engineering, but he moved to innovation work in 2013 to follow an interest in healthcare. While Randy did not work directly in IT, he described his job as working closely with stakeholders, IT resources, and tech companies.

Mission Health focuses on advanced medical care in western North Carolina. Randy used his experience with innovative processes, methodologies, and product development to manage the Center for Innovation. It worked to “promote and accelerate innovation opportunities that would have a transformational impact on our health system.”

“A lot of our time was problem seeking,” Randy said. “We successfully identified significant, measurable problems that we needed to be solved, that healthcare needed to be solved, and we went out to solve them.” 

Randy’s team worked with vendors to apply solutions to problems. We talked about stakeholders and working with IT teams during this process through the lens of supporting an innovative process. I had little understanding of what “stakeholder” meant and how that played a role in project management, so Randy explained.

“An internal stakeholder is anybody who can provide valuable information relevant to the project that you’re going to work on who in turn will be impacted by that project,” he said. 

Identifying stakeholders in a project is a critical first step. As an example, Randy told me of a solution for patients who are injured in hospital falls. The hospital pays those bills, which are not reimbursed by insurance in most cases. A vendor came to the Center with technology to reduce falls for inpatients. Stakeholders were unit managers, nurse leads, and CEOs, along with IT managers. In the early days when Randy worked with IT developers, their focus was supporting operations rather than working on innovation projects.

The innovation department created a devoted group of IT members who worked on multiple projects and had vast knowledge of all things IT. This team acted as a liaison to pull in other resources when needed, Randy said, and that model worked well for the Center. 

Much of Randy’s work at the Center was done before Mission Health was acquired by HCA Healthcare in 2019. Randy offered advice about surviving an acquisition.

His first idea is that every employee should have an idea of their worth to the central network of a business. They should make sure their value is tied to that central or core network, as even though healthcare offers several models for innovation, there are greater values in healthcare services, such as a doctor’s services or IT’s problem-solving tech. 

In the midst of the pandemic, the Center for Innovation was dissolved. In Randy’s opinion, this was due to innovation not being at the forefront of what the health system’s goals were. He stressed that innovation is important, but operational excellence was of higher importance after the acquisition. Over time, this meant that the Center was no longer essential to the functioning of HCA.

“We were able to operate for a pretty long period of time, but we didn’t know where or how to fit in,” Randy said. “When COVID came along, the financial pressures were significant to the health system, and they were making some tough decisions to cut back anything that was not a core function.” 

HCA centralized a lot of roles, including IT support functions. Mission Health was a non-profit, community-run hospital, and HCA Healthcare is a national, publicly traded company. Adapting was tough, Randy said, but the center held on until COVID-19 hit the world.

“Having a dedicated set of resources in an organization that focuses on and drives innovation is a much more effective model,” he said. But, support and dedication are required even at the top level for innovation to be successful. Until that is done, innovation will not be successful no matter where it is.

Because of COVID-19’s impact on the healthcare system, Randy’s position was terminated in October 2020. He is looking for a job in which he can apply his engineering, innovation, and management skillset. He believes that COVID-19 has shown leaders that innovation can help organizations prepare for future disasters. “Technologies that have been around or have been moderately tested or applied or used, such as virtual care, really accelerated,” Randy said. “It has now become the new standard.” 

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TDLR; Katie the Intern spoke to a department manager of an innovation center about the importance of innovation and project management, acquisitions, and job termination. 

That’s it for this week! I’ll back early February with my first virtual video interview / conversation. Until then, have a great one! 

Katie The Intern

Email me or connect with me on Twitter.

Katie the Intern 1/22/21

Hi, HIStalk! This week’s column is a Q&A with Kyna Fong, PhD, CEO and co-founder of Elation Health. This is the first column I’ve conducted in a written question and answer format. We touched on Elation Health, the evolution of primary care, COVID-19’s long-term impacts, and more. This column is a bit longer than usual, but I hope you find it to be an impactful and insightful read!

Dr. Fong’s journey with healthcare began at a young age, as her father served as a physician in Canada and the United States. As a teenager, Dr. Fong helped with in-house clinical services, which inspired her to become an assistant professor of economics at Stanford University. She and her brother then started Elation Health to deliver technology for independent primary care practices. 

Elation Health is a platform for primary care success, serving over 15,000 clinical users for their data management. The EHR is a collaborative, clinical-first system that supports physicians by managing clinical workflows, practice management, patient experience, and quality care. 

“Clinical-first is the radical idea that the quality of patient care matters and that supporting physicians is the path to that quality,” Dr. Fong said. “Our systems aren’t about upcoding, billing, and RVUs at the sacrifice of care. They’re about strengthening the patient-physician relationship and enhancing the craft of primary care.”

I asked Dr. Fong about technology that goes into running an EHR with a clinical-first outlook. Elation is a SaaS or cloud-based platform that relies on internet access. APIs (application programming Interface, noted) work behind the scenes to run data analytics and visualize information in real time. Dr. Fong said that Elation keeps the technology behind the scenes so users can focus on quality primary care. 

From Dr. Fong’s perspective, primary care and its evolution is the future of healthcare, and healthcare IT and holds the key to unlocking sustainable healthcare in the US. She cited studies that prove good patient-provider relationships lead to reduced healthcare costs and better livelihood. In this 2016 study, “Gordon and Beresin asserted that poor outcomes flow from an impaired doctor-patient relationship.” This understanding also leads to the conclusion that better healthcare relationships save time and money.

“That relationship drives reduced hospitalizations, less duplication of procedures, fewer medical errors, better prevention, increased chronic disease reversal, and more family involvement and trust in health decisions,” Dr. Fong said. 

The application of primary care is becoming more digital every day, growing at an exponential rate through telehealth’s application due to COVID-19. But not every area of the United States has been able to keep up with this digital move. Rural areas often have a higher population of underserved communities, and mom-and-pop healthcare practices are the only services available for miles. Dr. Fong says traditional EHR vendors require significant resources and technical support to successfully implement their services, and without large subsidies (which usually go to larger health systems), rural clinics struggle comparatively. Improving access and providership to underserved areas is important to assist rural practices in making the much-needed move to digital care. 

“These practices are so deeply invested in their communities,” Dr. Fong said. “Our goal is not only to see them survive, but to help them thrive, be recognized for high-quality patient care, and be paid what they deserve.” She believes that these underserved areas host tremendous opportunity for improvement, and with support, can begin to play catch-up in their digital development. I asked Dr. Fong what could be done to support rural areas and health systems in the switch to electronic records and how long would this take. 

In Elation and Dr. Fong’s experience, the answer lies in asking providers what they need and how they best tailor healthcare application to their communities. She said most rural providers and systems want “a healthcare structure that recognizes they are small businesses and not mini hospitals.” They want a system that reduces administrative burdens, offers purpose-built technology that is easy to develop and implement, makes data sharing and collaboration with larger systems easier, completes parity in pay for both in-person and digital / virtual healthcare in the pandemic, and offers support and pathways for moving to value-based care. 

The move to value-based care is also part of the problem in the evolution of primary care. Urban areas can sometimes have an easier time moving from FFS to VBC, but Dr. Fong tries not to see rural versus urban settings in this case. She views the challenge as being “more from the limited resources available to a small practice versus a large system, and the heavy financial and technical lift required of many health IT vendors’ legacy solutions to support alternative payment models.” Dr. Fong noted that smaller practices have a harder time getting the attention of payers to be able to invest in the shift to VBC. But for both large and small healthcare systems, monetary struggles and unmet incentives (such as reimbursement for VBC) can often hinder the move from a comfortable FFS model. 

As seen throughout the pandemic, the move to digital care can be done quickly and effectively. COVID-19 has in some ways leveled the playing field for the move towards value-based care. Primary care providers and their ability to practice have been supported by financial innovation to keep them afloat for their patients, Dr. Fong said. 

“We’ve seen big moves toward capitated and value-driven agreements for independent practices offered by payers across the country,” she observed. “The pandemic showed us starkly that the specialty-driven, fee-for-service model of healthcare fails to keep patients healthy when it really matters.”

Other surprising benefits of COVID-19’s presence have been technological advances and transitions. Movement to telehealth technology like Zoom and video-based platforms and the integration of these systems into EHRs were enhanced by the pandemic. This helped practices adopt new workflows to increase their treatment ability and reimbursement. She also said the shift towards telemedicine showed the world how quickly medicine can evolve when given the right incentives and support. 

“Primary care has a massive role to play in our national recovery from this pandemic in the years to come,” Dr. Fong said. 

Overall, the development of primary care is happening right before our eyes, she believes. Delivering the best possible outcome while also reducing cost of care are leading drivers in primary care’s evolution, and the pandemic has helped fuel that drive to make the switch faster and become a higher priority. Telemedicine, slowing the spread, and vaccine development are all just examples of the good that primary care does and glimpses into the future of its application. 

Lastly, Dr. Fong expressed her gratitude to those providers who have served the masses during this pandemic. “I see their sacrifice and their resilience, from practices in our community and my own dad’s clinic. Along with appreciation, they deserve support in helping build our country’s healthcare future.”

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That’s it, HIStalk! I’ve got some exciting ideas for some virtual interviews coming up, so if you have interest in watching 10-15 minute interviews or listening to some of my columns from a podcast POV, let me know! As always, I appreciate you and thank you for letting me learn about this industry. 

Katie The Intern

Email me or connect with me on Twitter.

Katie the Intern 1/15/21

Hi, HIStalk! I hope you’re well and that January is treating you just fine! I wanted to take the time to say thanks for reading my posts. I am learning fast!

This column is based on an interview with Natalia Southerland, MD from Brand New Med, PLLC. Dr. Southerland serves part-time at Crossover Health and is president of Brand New Med, PLLC in Texas.

I interviewed Dr. Southerland to discuss how primary care is changing, as well as how COVID-19 has impacted her as a provider. Dr. Southerland became a doctor to serve the underserved and to provide access to healthcare to everyone, particularly as an African American provider.

“Just trying to get people who are usually ignored by the system, trying to provide them quality care, has always been my goal,” Dr. Southerland said.

Dr. Southerland expanded her interest in medicine to wellness, as she is a sports-oriented and wellness-focused person and doctor. Initially interested in surgery, she focused her efforts on a more rounded approach to medicine alongside the ability to interact with patients, moving into family practice. She said inspiring people to take wellness into their own hands is important. She started Brand New Med to do just that.

“What was really missing for me was the ability to really spend time with people, and to really educate them about what was going on with them,” Dr. Southerland said. “I really wanted to serve people and get to the basis of chronic disease instead of just prescribing medication for chronic disease.”

Brand New Med combines a variety of wellness-centered treatments and services to inspire health protection and prevention. Movement and exercise, mental health and mindfulness work, sleep help, and relaxation are pivotal points in care that Brand New Med works towards. Dr. Southerland said that Brand New Med provides services that allow people to understand that they are more in control of their healthcare than they know.

Brand New Med had to adapt to COVID-19, just as primary care has also had to face the challenges the pandemic brought to light. Dr. Southerland said COVID has taken healthcare somewhere completely different than wellness. Healthcare is healthcare, she said, the treatment of illnesses. But wellness is the focus on feeling good, and that became harder to implement when a pandemic is looming over everyone’s head.

“I ended up actually moving my practice. My goal now is to help people really focus on the things that are going to keep them well,” Dr. Southerland said. “And putting together a program so people feel comfortable coming to the doctor not simply for sick visits, but for those visits that are going to keep them well.”

Providing wellness care virtually was a challenge, but learning how to adapt a wellness-centered healthcare space was not going to slow Dr. Southerland down. People were eager to do virtual visits, and the rare few took advantage of coming into a mostly empty office.

Dr. Southerland took this time to teach patients that if they have a particular medical condition, they can take charge of that at home. For example, a patient who has high blood pressure should keep a cuff at home and watch their pressure and learn to respond to it. Caring for patients from a virtual standpoint is easier when patients can gather information themselves at home, she said. Inspiring people to take control of their own healthcare will help the prevention of disease versus treatment of it become the new norm.

COVID-19 has changed the direction that both healthcare and healthcare IT are moving in general. Just as Brand New Med had to be moved and goals had to be changed, Dr. Southerland said the technology used to reach and treat patients was of utmost importance through the pandemic, and continues to be. Staying in contact with people through the pandemic was more important than ever, Dr. Southerland said.

“Using an EHR to send out mass messages to people, what information I got recently from the department of health, or information about where they get vaccines,” Dr. Southerland said. “Being able to contact them from that standpoint.”

Digitally contacting people is only one step in the evolution of primary care, as each day our internet-driven world becomes more entangled in the application of healthcare. Dr. Southerland believes there is catching up to be done in the healthcare IT industry, as she provided digital care during her time at the National Health Service back in 1995.

“It’s funny that COVID had to come to make it [digital care] the normal, or to make insurance feel that now it is OK to pay for it,” Dr. Southerland said. “I think this should become the new norm, and I think as we get better at making patients independent and giving them things that are going to help them help us diagnose them, then it is going to be better.”

The drawbacks to digital care are the obvious lack of physical examinations, but moving towards value-based, digital care can help build relationships in ways we might not have imagined. Dr. Southerland said a large part of the problem in moving towards value-based care is insurance payments, as doctors make more income when four people come into an office versus one person for an hour-long visit. But by moving to value-based care and instilling patient wellness, digital check-ins will become the new normal and new relationship between patients and providers.

“Moving to value-based care is valuable, but value-based care has to be couched into where you actually spend time with the patient to do what you need to do or have the ability to educate the patient in a way that the patient is actually going to become an independent healthcare provider and not dependent on the healthcare system,” Dr. Southerland said. “That relationship of not going back and forth, that has to be established.”

Dr. Southerland and I also talked about technologies that have helped her provide care during the pandemic, and where she hopes that tech will go. She mentioned the importance and ease of having a good EHR, and the ability for an EHR to change over time. Having communications, appointment making, video visits, payments and more all in the same place has been extremely beneficial throughout the pandemic, she said.

Other improving and useful technologies include wearable apps for monitoring blood sugars and other information will also be the future of helpful tech, Dr. Southerland said. Proactive care versus reactive care will benefit patients and providers alike, and technology can and will continue to help fill those gaps.

“Anything that is going to help the patient provide us with more information to diagnose and treat or to follow their condition is going to be a lot more helpful,” Dr. Southerland summarized. Any technology that allows for interaction with the patient, or allows group visits, etc. will be the future of primary care.

That is it today, HIStalk!

Katie The Intern

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TLDR: Dr. Natalia Southerland of Brand New Med, PLLC talks services and how COVID-19 impacted primary care in general. She believes moving towards value-based care is important but instilling overall patient wellness will help VBC become the new normal. “Really helping people to change their behavior is what is going to change the course of not just chronic disease, but primary care as well.”

Katie the Intern 1/8/21

Happy second week of 2021, HIStalk! It has proven to be interesting, in the least. I hope 2021 is treating you well so far. This column is a bit shorter than usual, so enjoy an easy read! 

This time around, I wanted to expand further on the conversation I had last week with TransformativeMed’s chief clinical officer, Rodrigo Martinez, MD. We talked about the concept of AI assistants, “spot solutions” in a clinical setting that aid in the treatment plan of patients. The idea for AI-powered assistants came first from a basic question — how can we help reduce some of the frustration that exists as part of the transcription process of being a physician? 

“The first phase for a lot of these [AI assistants] is that they are listening to the conversation between a physician and a patient,” Dr. Martinez said. “The ultimate intent of it is to transcribe that conversation, but also insert the different elements of text into the appropriate spot in the medical record.” 

That isn’t exactly easy to implement, though, as a large part of this AI software is reliant on machine learning. Say a patient and provider are both speaking in a room, and the AI assistant is listening through a microphone. In the initial phases of using this software, another person would have to be present to transcribe what is happening so that the machine can learn how to do so by itself. 

“It has to start to parse out, OK, when is the doctor speaking? When is the patient speaking?” Dr. Martinez said. “The machine learning over time starts to match and map and learn using natural language processing and converting a lot of those concepts. Rather, the algorithm starts to recognize it.” 

But the transcription doesn’t stop there. The AI assistant has to then learn how to place all of this information into a medical record correctly, learning where to place orders for future visits versus when the patient and doctor are talking about past symptoms. The software must take this information in in real time before converting it into orders. 

The concept of teaching AI to listen to a conversation and decipher it is not new. AI listening and problem solving software has been researched as early as the 1960s with Newell and Simon’s General Problem Solver. For healthcare IT, the application of AI-powered scribes has come leaps and bounds. 

A leading AI offering for this application is from Saykara, known as Kara the virtual assistant. Kara was developed to help eliminate charting and billing records after hours for OrthoIndy. Saykara works by pulling patient lists to capture, interpret, and transform data from conversation and summarization to then put it into the EHR. These types of services show a reduction in provider stress levels and eliminates after-hours charting. 

I asked Dr. Martinez if AI-powered assistants have helped relieve some of COVID-19’s burden. He said the potential to reduce contact with patients and provide hands-free care is promising. When it comes to telehealth and virtual appointments, AI assistants and scribes could grow to be the future of healthcare. 

“As more and more visits are moving to telehealth, there is a role for that AI-powered scribe to be recording that information and applying it,” Dr. Martinez sad. “I could see how the more and more you make things hands free, and make it easier to anticipate the next step that the nurse or physician needs to take, the better off folks are going to be.” 

The AI-listening concept may be off to a slow start, Dr. Martinez said, but the potential for outpatient treatment is more promising than in-person. In-person treatment usually has too many voices and people in a room for scribes to accurately transcribe. Ultimately, the future of these AI assistants lies in the hands of further development and machine learning.

Dr. Martinez said that the future of AI in medicine is promising, and that AI can be applied to a multitude of areas in healthcare IT and telemedicine. AI has the potential to make transcription and hands on care easier and safer, taking a weight off of healthcare providers in general.

“I think the concept of that is very fascinating and very interesting,” Dr. Martinez said. “I think there are a lot of potential applications to decreasing the administrative burden that is part of healthcare in the US.”

That’s it for this column! I hope you’re enjoying 2021 to the best of your ability, and stay safe out there! 

Katie The Intern

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Katie the Intern 1/1/21

Happy Holidays, HIStalk! I hope you had a great Christmas and are set to have a happy and safe New Year. This column offered a wide range of topics that I found really informational and interesting, so I’ll touch on a few of them and go more in-depth on some in the next column. Hope you enjoy! 

This time around, I spoke with Rodrigo Martinez, MD, a practicing otolaryngologist who describes himself as being “familiar with the gaps between many of the good ideas and technologies that are employed and why they often fail when implemented into the clinical environment.” I thought this would be an excellent intersection to discuss healthcare IT, as Dr. Martinez has experience in medicine, EHR strategy and consulting, and software implementation. 

Dr. Martinez serves as the chief clinical officer at TransformativeMed, a company that builds software for specialty-specific data visualization that embeds inside an EHR. TransformativeMed has worked inside Cerner and is moving into Epic in early 2021. Dr. Martinez’s start as a physician gave him an insight into the importance of incorporating physician-based ideas into EHR implementation to solve macro-level issues. 

“I have had an interest in how you take all of these different technologies and how you bring them into a clinical workflow,” he said. “In parallel, as you have more and more technologies that are consumer-focused, how do you create processes and workflows that stitch all of these different capabilities together?”

To create a workflow to start this process, a provider needs to have an EHR in place that can begin this implementation of different technologies. I realized I have not really asked past interviewees about that process, so Dr. Martinez spoke to this topic and how it has changed over time. 

A decade ago, a provider would start with an overhaul of processes and select an EHR that could best support them, Dr. Martinez said. The push for the use of these electronic healthcare records by government began in 2009, and rewards were given to those companies that selected EHRs that met Meaningful Use criteria. 

“What that did was create an enormous rush to implement electronic health records,” Dr. Martinez said. “That’s why you have seen, over the last 10 years, such a dramatic increase in the adoption– or at the very least, implementation — of electronic health records.”

Today, EHR concerns center on how a facility can maintain the best access to data. Access to data and the use of EHRs to manage that task are incredibly important because of CMS incentives and repercussions. In sheer numbers, an estimated 97% of hospitals nationwide used EHR data in 2017, compared to 87% in 2015. This jump in usage means that health systems can no longer afford to use just any EHR, but need a system that can manage data from multiple sources. 

“You’re seeing health systems go after a single EHR system in an attempt to try to maintain the cleanest flow of data,” Dr. Martinez said. “Once a patient starts to move in and out of one system or another, you lose the ability to quickly and cleanly access and move data, or you’re forcing the end-users, the physician or the nurse, to jump into and out of different systems.” 

Though so many clinics and providers have EHRs in place, Dr. Martinez said many of these EHRs are not well adapted and do not provide the benefit that vendors originally promised. This is where his intersection of ideas comes into play, and where TransformativeMed embeds solutions that improve clinical collaboration across inpatient care teams. 

Closing the gap between what an EHR can do and what an EHR does for a provider group is an important task to Dr. Martinez. Some of the tools that his company creates has begun to do just that. The specialty-specific views of data, called the Core Clinical Workflows, allows a provider to gather specific patient and specialty information without sorting through the clutter of multiple specialties. 

“Usually, the EHRs are set up with fairly generic-looking displays of data,” Dr. Martinez said. “We have pre-optimized or curated ways of looking at the information so that there is less hunting around for information, so you’re increasing the workflow efficiency.”

This data is available on desktop and mobile devices, as well as in app form for some specific decision-support tools. The software also allows for easier patient handoff and task management. This fingertip access supplies an easier and faster process for providers who are focusing on patient health decisions. 

The app that Dr. Martinez specifically spoke about was the Core Diabetes App, a tool for inpatient diabetes management. The backbone of a clinical support tool is reliant upon information about a patient’s state in an illness (in this case, diabetes). This app focuses on a single disease state, Dr. Martinez said, and combines all of a patient’s data in real time for up-to-date information that can impact decisions around care.

“The software is reading all of the vital signs and the glucose and blood pressures and a bunch of other elements, and it combines all of that information and it presents it in a very easily digestible and actionable format,” Dr. Martinez said. “The end user can standardize those protocols and can scale them across the entire health system. That is a huge step in driving evidence-based care for diabetes.”

If a clinician is able to see all of the combined information in real time, they are better able to make a decision about care. Providers are always able to act on the most recent evidence and information. This app is targeted at monitoring and managing diabetes, but what about other diseases?

Dr. Martinez said that many diseases can be monitored in similar fashion to diabetes, watching and managing those high and low levels and keeping a patient within them. For example, alcohol withdrawal, the regulation and management of blood thinners, and even pain management are all illnesses that could be managed or monitored through a similar system. It comes down to working with individual health systems on what they need to monitor the most.

“There are a number of things and we have really been exploring what are some of the other conditions that hospitals and health systems are prioritizing,” Dr. Martinez said. “Then, by partnering with them, we co-develop these different capabilities.”

Dr. Martinez and I also covered the idea of AI powered assistants and their application, which I believe I will focus on for the next column.

I am enjoying learning about the tech side of integration in these manners, and I’d love to write and research more about them for future columns. So that is it for this one!

Happy New Year! I cannot be the only one to say that I am excited to send 2020 off with a bang!

Katie The Intern

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Katie the Intern 12/18/20

This week’s focus was on how healthcare has begun to change from a fee-for-service model to a value-based model for some providers. I interviewed Matt Lambert, MD, who has served as chief medical officer at Curation Health for the past two years. Dr. Lambert is a practicing provider who has also authored multiple books about healthcare. 

Curation Health is a technology and services company that helps healthcare providers and organizations transition from fee-for-service to value-based care, Dr. Lambert said. Curation Health uses tools to sort data so that providers can capture certain diagnoses for their patients. 

“Physicians never signed up to be data managers,” Dr. Lambert said. “So anything that we can do to help manage data and the regulation for them is usually pretty well received by providers.” 

I know that 99% of HIStalk readers probably know the difference between the two models of healthcare application, but as someone new to the IT field, I asked Dr. Lambert just how different they are. Value-based care reimburses on outcomes, while fee-for-service reimburses on volume, he said.

“The currency of value-based care is some very specific diagnoses that need to be made and need to be managed on a yearly basis in order for you to get compensation for managing the complexity of your patients,” Dr. Lambert said. 

As we talked about what Curation Health does, we also focused on how the pandemic impacted the trend of shifting to value-based care.

“This shift was happening already,” Dr. Lambert said. “The payers are always more nimble than the providers. Providers are lagging in the transition into this.” Health systems and providers are built on a system that requires month-to-month, short-term investments, but value-based care gets reimbursed yearly.

“Just by definition, you have to have the ability to look a year down the road and say, hey, we’re going to make some changes to our business model now, it’s going to pay off in a year,” Dr. Lambert said. “But most health systems aren’t created that way. They’re built off of fee-for-service models.”

Establishing reimbursement for care isn’t the only struggle that providers face when adjusting to value-based care. Dr. Lambert said providers also have to learn how to document their care differently, as well as work against the typical workflow of an EHR. The typical workflow is designed to have an output of an E&M code (evaluation and management, got it), which is a fee-for-service model component.

“One of the reasons why providers are struggling in the shift to value-based care is because we’re asking them to do something they weren’t trained to do with a tool that is not designed to do it,” Dr. Lambert said. 

The shift towards value-based care was implemented in 2008, and providers are still struggling to make the switch. I wondered how COVID-19 affected it.

Dr. Lambert said that COVID-19 slowed down the ability for providers to physically see patients in a face-to-face manner because in order to get credit for managing a patient, providers have to physically see them. That is, providers used to have to do so. 

Dr. Lambert mentioned that the initial shift to value-based care was driven by CMS (Centers for Medicare and Medicaid Services, noted). When the pandemic hit, CMS was quick to deregulate the rules for reimbursement through value-based care.

“Telehealth became eligible for a risk-adjustment visit for value-based care visit,” Dr. Lambert said. Here, telehealth strictly means a video visit, as “telephonic” visits do not qualify as value-based care as of now. Dr. Lambert said CMS removed the HIPAA compliance requirements for a lot of visits, allowing more access to patients and a wider medium for providers. 

Though moving to value-based care is not the easiest task, adjusting to this new system of care is important for providers. According to Dr. Lambert, it isn’t just a care-based adjustment, but also a business one. 

“This is how the payers are going to reimburse you, and moving forward, if you continue to do things the same way, you’re going to fall behind in the way you get reimbursed,” Dr. Lambert said. 

Dr. Lambert also said value-based care is set up to compensate for and incentivize different things. It is set up to incentivize information sharing and care coordination, which encourages patients to be engaged with doctors and their health. It does so in a way that encourages outcomes, not just in the idea that a patient has to come back the following week or month, he said. 

Overall, Dr. Lambert says value-based care will to continue to grow through commercial and public incentives. He said there will be a lag into 2021 due to all the closures and limited care from the pandemic. But afterwards, there will be an increase in utilization and in compensation. He isn’t sure exactly where value-based care is going, but did say telemedicine improved dramatically through COVID-19 and will continue to do so. Perhaps that intersection of telemedicine and value-based care will be a sweet spot in providing better care and compensation for all. 

“It’s not very often in our lives that we try something new until circumstances force us to do that,” Dr. Lambert said.

That’s it for this week! Thanks, HIStalk! 

Katie The Intern

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Katie the Intern 12/11/20

Today’s column focuses on the data usage side of healthcare IT and telemedicine, which applies data and research to ongoing studies of both cancer and COVID-19. I’ll focus on the cancer side first and then end with how COVID both impacted and fueled the research of Boston-based Cota Healthcare.

I spoke with Mike Doyle, MBA, who has been president and CEO of Cota for the past two years. Cota uses advanced technology and analytics to provide and advance care and research for many types of cancer. 

“Our mission is bringing clarity to cancer,” Mike said. “Cota was founded on the ability to create objective ways of treating patients and tracking patients based on their outcomes.”

Cota was born from the idea that when cancer patients are seeking treatment, they are looking for answers to two questions: How many people have you treated just like me, and what were their outcomes? The founding doctors and engineers paired up with data scientists to provide a way to answer those questions. Their answer was something called a Cota Nodal Address, or CNA for short.

“What the Dewey Decimal system did for library books, the CNA can do for oncology,” Mike said. “It incorporates all of the relevant pieces of information that the treating physician needs to know about the patient.” 

Relevant information about a patient can include genomic information, disease progression, and other characteristics that would help to eliminate variation in cancer care. Organizations, Mike said, would help providers apply care as their patient’s needs changed over time. The CNA number is a snapshot of where the patient in their care. It adjusts as care is provided based on information from their EHRs.

The CNA number is something that had to be developed over time using trial data from hundreds to millions of cancer patients. Most interestingly, Cota wanted to replace real-world patients who receive placebo drugs in trials with data, thereby almost eliminating the risk that participants in trials might receive an ineffective placebo drug. When Mike was thinking about this process, he was thinking about making trials fair and effective. The 21st Century Cures Act also pushed for this change. 

“If there was a better way to use data to take the place of the placebo group, you’d actually have a much better way of speeding drug trials and greatly reducing potential deaths,” Mike said. “We thought that this was a good place to … work with clinical science companies in clinical trials to speed up drug discovery.”

Cota possesses some of the largest data sets for cancer patients in the United States, and either uses or supplies that data for trials and research. Cota has access to almost 2.5 million records, all data that can be used for quicker research. These large data sets are used by life science companies, Mike said, but they aren’t the only ones interested in the data the Cota has available. 

When COVID-19 began to take over the world, the FDA wanted specific information from Cota. Cota helped study the records of 3,000 records of COVID-19 patients to identify that hydroxychloroquine is not effective for inpatient treatment and may even increase risks in those with comorbidities. The FDA then asked Cota to continue its research on COVID-19 data. 

“We weren’t necessarily in the business of COVID, but rather quickly had to become in the business of COVID,” Mike said. Cota had signed into a partnership with the FDA three years prior, and their research on COVID-19 data prompted a new partnership for another three years to study COVID-19 and cancer.

Mark said the FDA wanted Cota to look at COVID-19 as a comorbidity to cancer. Cota’s ability to adapt to the study proved important to both the pandemic and to the continuation of cancer research. In ways, COVID-19 fueled the company’s already growing data sets.

As far as the future of Cota, Mike said that its research will remain cancer focused, but it will continue to study COVID-19 and cancer together. Data is the driving factor behind the trials and research on cancer. Cota will work with multiple institutions and providers that use its data for different studies, and Mike says they will continue to create partnerships with institutions to further research. 

In regards to HIStalk, Mike has read the website for years. He found HIStalk during his time at a different company, but now reads it twice a week to stay in the know. He has visited HIStalk receptions at HIMSS and now follows posts for the editorial and objective content that they offer. 

“To stay close to providers, I like to read it to stay close to what providers are thinking about,” Mike said. “I read about how we can help providers do a better job on the front lines with patients.” 

That’s the column for this week! I enjoyed learning about data usage in information technology and how a company has used COVID-19 to further its data and research abilities. I’d love to learn more about the application of data in a trial and how data can be used as a placebo in place of a person.

“Adversity creates innovation,” Mike said at the end of our interview. I am inspired to be learning about an industry that continues to help others by creatively innovating and applying tools. 

Have a great one! 

Katie The Intern 

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Katie the Intern 12/4/20

Howdy, HIStalk readers! I hope you all had a fantastic Thanksgiving and are looking forward to Christmas and the rest of the holiday season. As always, thanks for reading my columns and I greatly appreciate every comment and email (I’m behind on those replies, but thank you!)

This column will cover a great interview I had with Nick Wanner, MPAS, PA, a physician assistant who serves as a clinical advisor for a healthcare vertical team at Avtex. Our discussion surrounding telehealth and its advances was eye-opening to how fast telehealth has moved forward. Nick has been practicing medicine for three years, but he said his clinic used telehealth relatively often even before the outbreak of COVID. He worked on a project to bring telehealth into his practice early on in his career.

“I had a capstone project for our PA program,” Nick said. “My focus was on bringing a telehealth program into a bigger organization.”

The program aimed to bring telemedicine to a primary care facility and eventually into a specialty care program. In early 2017, Nick was put on a design team for formulating a telemedicine program at work and helping install the formal telemedicine program. By 2018, phone visits were a regular occurrence at the clinic.

As a consumer of medical care myself, I found this interesting, as I had never really heard of seeing a doctor online or over the phone before COVID. It’s highly possible this is because I’ve always been healthy and also have no issues going into doctors appointments. Still, I found it fascinating that telehealth was on the market way before COVID.

I asked Nick about his experience with telehealth before the pandemic, how often he used it with patients, how usable it was, and how much experience he had with it. Outside of his experience with designing a telemedicine program, Nick said that the clinic he works at was already leaning towards virtual and online video visits before the pandemic. His clinic had plans to push for more telehealth usage beginning in 2020.

“Video was on the docket for us as a group this year,” Nick said. “We basically had the infrastructure ready, we knew what video service we were going to use, and we had all the marketing. So it just got pushed forward.”

Nick said that before COVID, the average telehealth appointment was for college students who were away from home or people who wanted to stay home and use a virtual visit. He said telehealth was limited in use, but since COVID, it’s become more common.

“Since COVID has come around, [telehealth] has been more of a mainstay at our practice,” Nick said. “We’re kind of advocating between 30-35% of our visits as telemedicine, both video and phone.”

When I first heard 30-35%, I’ll admit I thought that was low for COVID’s impact on the necessity of telehealth. Nick clarified that year to date through November, his group has completed over 500,000 video visits alone, assuming closer to 750,000 for a more up-to-date number. He used the words “rocket ship takeoff” to describe the trend.

We all could have guessed that telehealth would be heavily used during COVID as safety has become such a large part of slowing the spread. But what are the other benefits of telehealth? And where is it falling short?

Nick said that as far as the benefits of telehealth, the major pros are lower costs and more transparency for phone and video visits, patient satisfaction in relation to being able to talk to a doctor long distance, reduced overhead for providers and fewer staffing issues, and the general overall comfort that this trend won’t go away.

“Once people buy into this, we’re seeing that people keep coming back to it,” Nick said. “We’re seeing a huge portion of patients that really are enjoying these visits.”

As far as the cons, Nick said that one of the biggest is “managing that fine line between convenience and ease of access at appropriate clinical quality.” Clinicians and providers have voiced this concern often, Nick said, along with a lack of physical touch for examinations and hands-on care.

“There’s nothing that can replace that,” Nick said. “I think that is part of the art of medicine.”

Nick also said that just because telehealth aids in lessening the amount of in-person care initially, it can still lead to physical, in-person follow-up appointments and hospital visits. Nick said that it is important to teach patients how to appropriately use telemedicine and only when physical care is not an absolute need.

“We don’t want to miss those big, bad wolves out there just at the expense of convenience,” Nick said.

I found the pros and cons useful to hear from a provider, but I also wanted to know where providers need it to go from here to continue its growth and its ability to treat people with high quality care.

Nick focused on the need for a software / telehealth system that provides high quality and ease of access to both patient and provider. He said having a system that could allow patients to upload their own numbers and pictures without going through texts and messages would help.

“I think that if there’s a group that came on that provided a really great experience for both the patient and the clinician, and that could integrate information from an electronic health record … I think would be a really awesome thing for a lot of clinical providers,” Nick said.

Overall, Nick said that having options for patients that are safe and quality-driven but still promote revenue for the health system is where telehealth needs to go. He said that, so far, he has seen this as a trend and hopes that it continues to develop with those needs in mind.

That’s it for today’s column! I enjoyed talking with Nick and learning about the provider side telehealth. Next week I am hoping to speak with someone about how cancer trials and telehealth have overlapped throughout COVID. Until then, have a great week!

Katie The Intern

TLDR; Katie interviewed a PA who discussed to pros and cons of the rise of telehealth. Pros include access and lower costs, while cons include a lack of physical examination capabilities. He also said that healthcare needs to continue to grow with a focus of providing quality care that also promotes revenue.

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Katie the Intern 11/27/20

Happy Thanksgiving, HIStalk! I hope you all had a wonderful and safe holiday yesterday. I know this Thanksgiving looked very different for the majority of us this year, but I hope your day was spent giving thanks and enjoying time with friends and family (distanced or not)!

This column will focus on another interview with a professional in the healthcare IT industry. This time, the focus leaned on the now and the next of healthcare IT throughout the pandemic. I really learned a lot about the nature of healthcare IT’s growth during strenuous times like these, and I hope this column relays some of that well.

Mike Pietig works for Avtex Solutions, an IT service management company founded in 1972 that offers full-service customer experience consulting and solutions. “Avtex is in the business of helping their clients deliver an exceptional experience to their own customers,” Mike said.

Mike has been with Avtex for a year, focusing on a healthcare line for customers who use the company. Avtex needed someone who was familiar with healthcare, who knew the right terms, regulatory requirements, and connections in the field. His role has helped the healthcare line of Avtex Solutions grow faster.

Because Avtex Solutions is a connection solution builder, the company is always seeking ways to solve problems and develop strategies for doing so. Mike has been in the healthcare IT field for about 17 years, and coupled with his workplace’s goals, I figured he would be a great person to talk about the major changes in healthcare IT. We broke it down into two major questions — how has healthcare IT changed and where is healthcare IT going next?

“The first big change was driven by regulatory requirements, government change that forced the healthcare industry to implement electronic medical records and other solutions to satisfy their requirements,” Mike said. “The innovation was happening within individual hospitals, but it wasn’t happening across an entire industry, so the government mandated some of those.”

Mike mentioned regulatory requirements such as the Affordable Care Act and the HITECH Act, both of which were written between 10 to 15 years ago and enforced more accessibility to health insurance and the use of EHRs. These rulings further pressed the healthcare industry as a whole to create platforms that were usable, valuable, affordable, and high speed.

Mike then turned to the pandemic itself to discuss another major change in the healthcare IT industry. COVID-19’s presence has acted as an accelerant that boosted the growth of telehealth, and prompted IT professionals to really ask how and why patients could get better care in a safe environment.

“I would say [COVID-19] probably accelerated innovation by somewhere between five years on the low end to 10 years on the high end, in terms of the technology solutions,” Mike said. “Also in terms of the adoption of telehealth, and virtual visits, and digital front doors, and the idea of consumer-driven healthcare.”

Mike also mentioned a client that had a year-long goal to implement telehealth in nine areas of their hospital. When the pandemic hit, the hospital knew they had to get telehealth going fast, and implemented all nine areas within six weeks.

Mike’s words lead me to think about COVID-19’s impact on not just healthcare in general, but at the fundamental level of how care is delivered. He said that patients need to be treated as a consumer, as someone who has choices where to go and how to get care instead of someone only interested in need-based care.

“We have to deliver a really great experience,” Mike said. “Because otherwise, those customers can take their business elsewhere. Healthcare is now really starting to recognize that.”

I was very curious about this trend, about why COVID-19 acted as a catalyst in a consumer-driven market during a time where the consumer is not necessarily the driving factor. Consumers are benefitting from the exponential growth of the healthcare IT market during a global pandemic because of how quickly providers have had to innovate solutions for safe patient care that slows the spread of the virus.

“We’ve got so many choices now that I’m going to go where I feel I can get the best outcomes and the best value and the best experience,” Mike said. “That is fundamentally different now than the way it has ever been in healthcare.”

Mike’s answers to the next part of my questions were just as interesting. Where is healthcare IT going next? If we’ve grown and adapted so quickly, what could possibly be next?

“I don’t think the technology will go away,” Mike said. “I think there is even more openness or an appetite to new ideas coming into healthcare because everybody is trying to figure out, ‘how do I do more with less?’”

Mike reflected on a recent survey of over 1,000 patients to find out what was important to them during this time in healthcare. Patients don’t want to wait in waiting rooms, touch clipboards, or touch a kiosk, Mike said. The top 10 concerns from respondents were centered on safety. The survey showed that people want quick, efficient, and safe care. Is this the trend that the future of healthcare IT will continue to follow?

Healthcare IT will continue to move forward, most likely with a heavy emphasis on telehealth and its ease of application. But Mike did say that the approval of initiatives is what takes the longest and can be the hardest to do. If an initiative or an idea can prove to be applicable not just when someone is sick, but all year round, it can move forward.

“If you’ve got a strong business case and you can generate more revenue, or measure the expected savings, people will still find the funding for it,” Mike said.

Mike talked a lot about how much he reads HIStalk and how impactful it is to him for work and for understanding the industry. I wanted this column to focus more on healthcare IT, but Mike did say that HIStalk is in his top three reading recommendations for newcomers at his work and for anyone new to the industry.

I know I mentioned doing some research on COVID deaths, but I received an interesting comment that I’d like to do a column on beforehand, if possible. User Kermit mentioned that a friend of theirs is a therapist, and I’d love to interview a therapist currently using a telehealth service to hear their ideas of the pros and cons surrounding its usage. Mr. HIStalk and I discussed the importance of researching the provider side of telehealth. I’d also love to interview a doctor about these aspects, so if you’re either of those or know someone, I’d love to connect.

That’s it for today! I hope you had a great Thanksgiving, and happy Friday!

Katie The Intern

TLDR: Katie The Intern interviewed Mike Pietig from Avtex Solutions. Mike said that the two major changes in healthcare IT over the years have been regulatory requirements and the pandemic as an accelerant for growth.

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Katie the Intern 11/20/20

Howdy, HIStalk readers! I’m back with another interview column that covers a HIStalk reader who is a professional in the field. On top of learning about the healthcare industry and the consulting side of IT, I also got some great advice about how to take a deep dive into learning about the ecosphere as a whole. Buckle up! 

I interviewed Zack Henderson with Pivot Point Consulting last week. Zack is a senior consultant who works in the implementation of Epic’s different modules and programs. “I work really closely with their analysts, their users, the operational leadership to develop training programs,” Zack said. “Specifically, for their emergency departments, their obstetrics, their long-term care, and case management control.”

I asked Zack to explain to me a little about what Pivot Point does, as I am unfamiliar with the term “consultant” in its application to healthcare IT. Zack said that his company works with several clients in a five-hospital health system in Illinois where he is based, but also across the United States. Pivot Point works on EHRs, ERP (Enterprise Resource Planning, yes, it has been added to my Google doc of abbreviations), analytics, telehealth, and other projects. He has been with Pivot Point for about a year. 

Before Pivot Point, Zack worked for Epic. Zack, like most Epic employees, was brought into Epic with little experience and no history as an HIStalk reader. 

“I came across HIStalk when I started working at Epic. It was one of the online sources that they [Epic] recommended we visit and try to go explore,” Zack said. “It was a great source for a lot of us, and it continues to be. Being able to read those stories and asking, how is that going to change the work that I am doing in a year? In five years?” 

I found it fascinating that Epic encouraged employees to read HIStalk and other IT blogs to gain experience. It is eye-opening for someone who is new to the field and new to HIStalk to see the reach of HIStalk and its impact. Zack said that HIStalk helped him become familiar with how many different aspects there are in the healthcare IT world. 

“Having moved on and into the consultant world, every day I feel like I learn about a new app or a new regulation or a new feature to try out or a new product that is being brought to market,” Zack said. 

There were stories and discussions that were used for training at Epic, Zack said, but much of his HIStalk reading was used to look at the macro level of the health care industry — where the industry is going, new tech such as AI and voice activation, and cool things that are happening. HIStalk keeps Zack in the loop of what is new to the industry. 

“I visit HIStalk about every other day and find it to be a great one-stop shop for keeping up with everything going on in the world of healthcare IT,” Zack said. “I pay particular attention to news about EHRs, specifically news about Epic customers as well as stories about mergers, acquisitions, divestitures, and strategic HIT efforts by health systems.”

Zach also talked about how he appreciates the variety of pieces that HIStalk covers, sharing his love for the various interviews that help him understand what problems and solutions are being solved with technology. He also said that Dr. Jayne’s columns remind him of the impact that technology has on and with patient care. 

“The world of healthcare IT is so broad and there’s always something new and cool being worked on,” Zack said. He’s not exaggerating, as I am just beginning to learn the intersections of healthcare and technology and their interconnected impact on each other and on the world. I asked Zack for some advice about learning and understanding these things better as I become more immersed in the industry. His main piece of advice was to research some of the historical aspects of the healthcare IT world. He mentioned researching Dr. Plummer at Mayo back in the 1900s, so I did just that. 

Dr. Henry Plummer was a scientist and engineer who entered the healthcare field as a physician’s assistant in the late 1800s. Even before working in the health field, Dr. Plummer took an interest in the endocrine system at the age of 16. This lead to a medical degree from Northwestern University, which fueled his impactful medical career. 

Dr. Plummer was hired by Dr. William Mayo, director of the fledgling Mayo Clinic, in 1901. Dr. Plummer wanted to create a streamlined system of patient information access because doctors originally only kept single notes on separate patients. Alongside his colleague, Mabel Root, Dr. Plummer initiated a chart system of patients so that doctors could easily access information in one place. The medical record was born on July 1, 1907, and has only grown from there. Dr. Plummer served Mayo Clinic until his death in 1936. 

Zack’s advice to look at this history led to more research about how quickly the EHR developed over time. Hardware became more widely available as early as the 1920s, and though the internet was not created until the 1960s, the growth of the health records system was consistently exponential. While there was only one health record in 1907 at just one clinic (Mayo), as of 2017 86% of office-based physicians use or have used an EHR. 

Understanding an important piece of the healthcare IT world, EHRs, has given me a strong foundation into the impact of technology and how it can literally change and save lives. I enjoyed learning about Dr. Plummer and the growth of the health records system, now electronic, and want to continue this kind of historical study. The technological advances we know in this industry today were developed from a single idea, and as Zack said, Dr. Palmer “…really set the course for where we are now.” 

I think the best piece of advice I received from this interview is something that I am coming to find as I learn. I’ll let Zack’s quote end us out, as he says it best. 

“Healthcare IT is just really cool. The macro-level work that we get to do in this field is really, really cool and we get to impact millions of lives.” 

That’s it for today! Hope you all have a great weekend. Thanks, as always, for reading and for welcoming me. 

Katie The Intern

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Katie the Intern 11/13/20

My learning this week consisted of interviews with readers of HIStalk. These readers also work in healthcare IT and either use HIStalk to some capacity for their job or rely on HIStalk updates to stay in-the-know for work updates. I’ll be summarizing one of those interviews and some of what I have learned about healthcare IT from it as well. 

This interview was with a gentleman I’ll call Steven since he prefers to remain anonymous. Steven works at a hospital as an Epic data architect. As he described to me, his job revolves around how to best make use of the reporting software that is in the hospital’s contract with Epic. Steven says that the hospital’s contract is structured under a strict fee, so the more the hospital uses it, the more benefit the hospital receives. Value is maximized when benefit is increased without a cost increase. All right!

When Steven started at his position, his hospital was just beginning to implement Epic. He had gained experience with Epic from his previous job with a pharma-related company. That is where he was introduced to HIStalk, as he started on the vendor side and moved to the provider side, where he has been for more than five years. 

“That was kind of like a dream of mine, to switch out of the vendor and onto the provider side,” Steven says. “Now I work on the provider side, and it’s kind of a glorious, wonderful thing. It was super meaningful even before the virus hit, and then the virus hit. All of a sudden my job changed dramatically and took on even more meaning.” 

Steven uses HIStalk to understand the general direction of where to take Epic at the hospital. HIStalk helps him understand the direction of the healthcare IT industry in general, allowing his team to make decisions about when to invest in additional effort in Epic or consider using another vendor. 

Before going too much into the interview, I wanted to write about what I learned about Epic and other EHRs (electronic health records, point for me) vendors. I’m sure HIStalk readers understand Epic and EHRs, but for me, this interview revealed a lot about how some of Epic’s programs are used by architects and applied to patients, staff, and hospital data. 

Epic has a software package called Cogito, an analytical database that allows the analysis of patient data as a whole rather than one patient’s data. Steven touched on Epic’s systems known as OLTP (Online Transaction Processing) and OLAP (Online Analytical Processing) and their different uses inside of Epic. The OLTP is useful for looking at one single point for data references, such as a single patient or a provider’s schedule. The OLAP makes it easy to search across an entire population, Steven says. These processes are the analytical tools that he uses to increase the value that his hospital gets from using Epic. 

Steven’s job revolves around understanding certain sets of data to ensure the hospital is able to get the information they need. He uses that information to answer the hospital’s questions, such as which doctor has the most expenses, how financials are doing, or how efficiently the hospital has vaccinated patients.

“I lead a team of 12 and I call the technical shots on how we are going to meet the businesses needs in being able to understand the data across the whole environment,” Steven says. 

This is where HIStalk comes back into play for Steven. He often uses HIStalk to guide his arguments for or against the renewal or discontinuation of programs for his hospital. Understanding the healthcare IT ecosystem allows Steven to see if the products his hospital is using are continuing to meet the needs of providers and patients there. 

“Being aware of what startups are doing or who is buying what helps me make arguments for or against whatever approach people are wanting to talk about in the data space,” Steven says. “Knowing what is happening outside of that, what their competitors are doing, helps me understand, ‘Is this person’s desire for this thing, is that what is best for us?’”

It is this understanding of desire and needs that recently drove Steven to argue for the discontinuation of a software program that many hospitals use. He argued to not renew a contract with a vendor program made by SAP Business Objects, business intelligence software that is not meeting his hospital’s needs. Though it is a partner’s software that Epic recommended, the hospital will be one of the first to turn it off. 

Much of this interview with Steven brought me to a deeper understanding of the crosshairs of analytics, vendors, and running a hospital’s data systems to maximize value. Researching EHRs, talking with Steven, and learning more about the main players in the EHR industry has been eye-opening for me as someone new to the field. I really learned just how important it is to stay connected to the industry, as it helps healthcare IT workers better apply system tools to patients and providers alike.

I do hope this column helped readers gain at least a deeper understanding of the role of a data architect in hospitals. I know that I learned a great deal about Epic, computer software, data analysis, and understanding the importance of keeping up with the industry.

In next week’s column, I’ll be breaking down another interview with another reader who uses HIStalk to stay connected. He is a younger professional in the field and also gave interesting tips on how to learn about the industry as a whole.  

I also plan to begin researching COVID-19 deaths and how hospitals decipher who died strictly from COVID-19 versus from complications it caused. I am hoping to share some interesting information from that research in the coming weeks! 

Thank you for reading. I am enjoying the healthcare IT industry and learning new stuff every day. 

Katie The Intern 

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TLDR, as a reader requested – Katie The Intern conducted an interview with an Epic data architect and learned about EHRs, data evaluation, and how an architect makes decisions at work with the help of HIStalk’s industry summary.

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Katie the Intern 11/6/20

Hi, HIStalk readers! Katie The Intern here. I’m back and somehow made it through my first week of learning healthcare IT. How do you all keep up with this industry with such poise?

I find myself wanting to be interesting and somewhat humorous. I Googled healthcare IT humor and found a Pinterest board full of IT jokes. Once I feel like I’ve earned a few throwaway dad jokes in the IT department, I’ll share them. If you have any, I’d love to read them! 

How Journalists Use Sources

Mr. H suggested that I briefly discuss how journalists choose and use sources. From my studies and experience in journalism, the best sources are sources that are timely and factual. You’ll think, jeez, you paid for that class? But, you’d be surprised how many sources I have replaced because the information they promised to have or the timeframe in which they promised to deliver that information fell through. There is no story without sources. There is no information to be shared unless that information is substantial to reporters. We choose sources and statistics that are tangible, honest, and valuable. 

That being said, sources must also be willing to talk to journalists about what they know. I briefly studied media law, and in my opinion, protecting a source can sometimes prove more valuable than the information itself. Establishing trust with private sources, especially those whose employment teeters on that information’s publicity, is a very valuable practice.

The protection of a journalist when using an anonymous source is known as a shield law. Shield laws vary from state to state, and do not completely provide protection in all cases. Shield laws come from the first amendment and allow a journalist to claim that consumers have a right to newsworthy information despite the source it comes from. This varies in court, medical journalism, private investigations, and others. 

Shield laws apply to publications that claim to be information sources, i.e., your average newspaper, online news hubs, and most of the places you read or watch news. Blogs and private boards typically do not fall under shield laws because the information is not classified as news, but as opinion. To be completely honest, I don’t know much more about media law and where the line is drawn when information is not bound to a specific state (HIStalk readers submit information from all over). But I will do more research and update you in my next post. I’ve been reviewing sites I read in school, and this Columbia Journalism Review article is a good start. 

What I can say is, a journalist’s reputability is on the line, too, when reporting with anonymous sources. A good journalist will do their research on a source and make sure they are who they claim to be and the information they are giving is factual. A good journalist will establish themselves as trustworthy and reputable so that readers feel they can trust what they’re reading.

Now for more of what I think about sourcing information on blogs! Opinion is valuable as long as it is labeled as opinion. Rumors are valuable as long as they are labeled as rumors. Sourcing for both should follow similar guidelines. Sources should be able to confirm where they obtained their information. Sources should confirm their connection to their information. Sources should provide as much documentation as possible. It is on the journalist to confirm that these things are valuable and truthful. As long as rumors can be substantiated (such as, this could be true, but it is a rumor), then reporting on them is fair and fun. Making private or rumored information public can be quite exhilarating. HIStalk readers seem to enjoy rumors and the discussions they sponsor. 

Thoughts on Health IT News Reporting

As a journalism major, I am finding great value in reading HIStalk even though I have never read much about healthcare IT. It has opened my eyes to niche industry reporting and blogging. I did not realize the scope of the HIStalk world and the worlds that it revolves in. Niche reporting is a safe industry, but the niche does have to be big enough to be sustainable. I am learning that finding a niche and being good at hosting discussions about it is quite sustainable. Mr. HIStalk has gotten this right for almost two decades, as you all know. 

I’ve been reading other sites and comparing their reporting practices with the aggregation and types of coverage that Mr. HIStalk uses for the news he posts. In one sense, HIStalk cannot compete with regular news, simply because the audience is expecting only healthcare IT news. Any other information would seem out of place and boring. On the other hand, HIStalk outpaces other healthcare IT sources because of its unique atmosphere of readers and discussion. Blogs and news are both competitive sources, but luckily they are competitive in their own niches and universes and not so much with each other.

My future columns will consist of what I am learning, interviews with young professionals in the IT field, interviews with marketers and PR people about how and why they use HIStalk, and more research on what I have been learning. 

I am also looking for a “beat,” so to speak, that I can write about each week. My first thoughts on this focus on the growth and prevalence of using telehealth to cut down treatment times in hospitals and clinics. For example, I talked to a family friend who discussed how telehealth saves time in diagnosing a stroke in a patient, allowing life-saving medication to be administered faster. It would be both entertaining and enlightening to interview various IT employees at different levels and get their take on what telehealth has done, what it can do in the future, and how fast it will grow. Mr. H suggested looking into news and information about consumerism in telehealth, which I am also interested in writing about but would certainly need ideas for expansion of that topic. 

If you have any ideas on expanding these topics or believe they would not be as interesting as I find them to be (being new to this field, I recognize some topics that I find exhilarating are old news to the professionals), do comment or send me an email. I’d love feedback and advice!

Overall, I feel I am learning a great deal from Mr. H, HIStalk readers, and from reading about healthcare IT online. I am very appreciative of those who took the time to send me emails, advice, and tips as I learn more about this field. Thank you for reading, and I look forward to furthering my HIStalk studies with you all. 

Katie The Intern

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Katie the Intern 10/30/20

Hi, HIStalk readers! My name is Katie and I am excited to be interning under Mr. H. He suggested my first entry be an introductory column about myself, my studies, and my interests in healthcare IT. 

To start, I’m a recent graduate with two part-time jobs and two side “gigs,” including this internship. I work a lot and my schedule is busy, but whose isn’t these days? I work in media communications, PR, and write for a local paper. Outside of work, I write and record music, read a lot, ride horses, and write. That just about sums me up. 

I graduated in May from a prestigious journalism school with a BA in journalism and media. I say “prestigious” because that is how it was described to me when I applied to the school, and it is one of the top-rated journalism schools in the United States. I call myself a “Covid Grad” as I lost the last three months of my collegiate career to the current pandemic. Obviously, this is not half the loss that many have faced during this time, but I do mourn the experiences and the connections I might have made had my time not been cut short.

I’ve often joked that graduating during a pandemic should be listed on my resume. Losing your last three months of college, obtaining a degree, not having graduation, moving back in with your family, and stepping into a globally crumbling economy should be listed as an acquired skill set. Anyone out there hiring? 

My studies focused on multimedia news. I have experience with photography, print, broadcast journalism, animation, interviewing, multimedia design, and writing. I am proud of the school I come from and very proud to have my degree.

I had hoped to work in breaking news reporting for a local paper. I still hope to one day do this, but as the industry changes to concise and fast-paced delivery, I know I have to expand my portfolio. I enjoy writing breaking news, interviewing, taking photos, producing videos, and getting information out in a timely manner. I believe that getting concise, factual, and interesting news and stories to the community is extremely important. 

I recently spoke with a reporter for a local paper that I have wanted to write for for some time. He is a sports reporter and is now only covering Covid news. This was an eye-opener for me about the state of the news industry and the state of the world. I remember teachers assuring myself and other students, “There will always be a need for news.” I believed them and I still do, but I am quickly learning that a need for news does not promise a need for true, journalistic storytelling. So here I am jumping into an industry I know very little about! 

To be fully transparent, I know next to nothing about healthcare IT. I even had to Google what IT meant and how that related to healthcare news and what Mr. H does. I have had an interest in healthcare since early college because I have a family member who is affected by healthcare legislation. My interest stems from a curiosity as to how healthcare impacts my sick family member and her caretakers. Information technology was not among those interests, but when Mr. H described to me the possibility of learning more about the field, I decided to give it a try. So thank you for your willingness to let me learn about your industry and what makes it tick. 

I hope to learn many skills during this internship, both from Mr. H and from this audience. I expect to learn how Mr. H aggregates sources and communicates with readers about those sources. I expect to further my journalistic skills such as concise writing, compelling interviewing, interesting and important storytelling, and more. I want to learn how sources report on what healthcare IT is doing and how media concentrate efforts in publishing that information as quickly and accurately as possible. I feel I will learn a lot from interviewing professionals in the healthcare IT field and from interviewing HIStalk readers.

I desire to learn as much as possible about healthcare IT itself. Information technology is a concise name for a robust industry. I hope to learn what IT is, what it involves, and how it impacts healthcare. I want to understand who develops healthcare IT and what pushes those developments forward. I want to learn how healthcare legislation is impacted by the IT industry. I want to learn how professionals in the field predict what IT will do next. I want to understand how the stock market is impacted by healthcare IT. The jargon in health care, information technology, and in Mr. H’s posts will also install a learning curve for me. I’ve been researching and learning acronyms that Mr. H and readers use. If I can get over that hump, I think I’ll be good to go. 

I believe that the more I learn about this field and what Mr. H does, the more I will want to expand that newfound knowledge. I fully expect the list of what I hope to learn to grow. I will be writing a weekly column about what I learn and researching healthcare information technology as much as I can. I will also be doing interviews with readers and sponsors. I would love to hear from healthcare IT marketing and PR workers who could describe to me what they do.

For now, I am excited (and thankful) to be able to step into your industry and to learn what it does. I am appreciative of your patience and willingness to teach me and to interact with me, and I look forward to diving into this internship more and more.

Thank you for reading. I do hope I’m even half as entertaining as Mr. H.

Best,
Katie the Intern

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