Readers Write: Clinical Trials and the Data Diversity Problem

Clinical Trials and the Data Diversity Problem
By Liz Beatty

Liz Beatty is chief strategy officer for Inato of Guilford, CT.

Minority and marginalized communities have historically been underrepresented in dozens of private sectors globally. This includes pharma, where there exists a steep chasm that drug makers have yet to bridge concerning research and trials – a chasm that directly impacts the quality, quantity, and diversity of data that determine the efficacy of a drug and its applicability to broad patient populations.

One needs to look no further than a retrospective review of 302 drug submissions to the FDA to find evidence of data problems. That review found that nearly 16% of submissions had insufficient data to determine safe dosages, more than 11% had inconsistent results between study sites, and about 13% failed to demonstrate statistically significant benefits. These findings suggest data limitations, including diversity, influence the FDA’s rejection of five out of six submissions.

The longer the trend of incomplete data exists, the harder it becomes to address. The feelings of mistrust, resentment, and disenfranchisement only get more complex to overcome with time. While there has been a concerted push by the pharmaceutical industry to improve the situation over the past decade, it’s not moving fast enough toward a solution.

The time has come for technologies to step in and innovate solutions for this situation once and for all.

Significant progress has been made in the public sector, particularly among studies funded by the National Institutes of Health (NIH) and the National Cancer Institute (NCI). However, the same cannot be said for industry-funded studies. For example, NIH requires grant applicants to include plans for recruiting women and members of minority groups, while the FDA released guidance focused on expanding eligibility criteria for such trials and discouraging unnecessary patient exclusions, as well as boosting the recruitment process in order to attract diverse patients. NCI also reported a 14% increase in minority participation among clinical trials it has funded over the past decade.

Among private-sector trials, however, little progress has been made with regards to inclusivity and diversity. The FDA reports that 75% of enrollees in trials for drugs it had recently approved were white, while just 8% were black and 6% were Asian. An NCI-funded study found that 9% of those participating in its SWOG Cancer Research Network trials were black, compared to fewer than 3% in trials sponsored by pharmaceutical companies. 

Nor is the diversity problem limited to race. Under-representation also extends to gender and even disease. For example, just 8% of cancer patients enroll in cancer trials, and less than 2% of cardiovascular disease trials reported any female sex-specific cardiovascular risk factors.

Historically, one barrier has been a lack of medical facilities with the capacity to host clinical trials in underserved areas. One NCI study found that 75% of patients don’t participate in trials simply because there are none in their area. Additional barriers for underserved patient populations included distrust of clinical trials, insufficient information about the participation process, limited time and/or resources, and lack of awareness.

The resulting lack of diversity impacts sponsors and clinical trials in three key areas:

• Accurate, robust data. The scientific method is null and void when data sets are incomplete. Yet a multitude of clinical trials continue to enroll smaller, homogeneous groups of patients who predominantly reside within a short travel distance of major trial sites. This should ring alarm bells for any drug maker seeking the efficacy and side effects of the medications they intend to bring to market. Incomplete data is a risk to the patient and treating physician, and it’s a financial and reputational risk to the business.
• Trial efficiency. Including broader demographic and geographic groups can accelerate trial speed and boost efficacy, while testing on a narrow participant group can result in unanticipated results after approval. Additionally, pharma companies that run fully representative trials are likely to experience greater success in reaching FDA approval for their medications.
• Financial incentives. Greater patient participation enables speedier trials and reduces costs, while a wider prospective candidate pool can reduce recruiting time, which drives down opportunity costs associated with delays that can run from $600,000 to $8 million per day. Further, better detection of side effects that might otherwise be missed when enrollment is limited — resulting in an incomplete picture of the treatment’s actual impact on the broader population – can prevent post-approval FDA black box designations and millions in lost revenues.

Increasing diversity and minority recruitment requires more than simply making a greater number of trials available in underserved areas; it also involves increasing engagement by partnering with community sites, using digital tools to enhance accessibility, and employing a diverse staff to better translate trial information to broader patient populations, all of which can be accomplished by embracing community-based research centers.

Powered by advances in remote patient monitoring and telemedicine technologies, decentralized trials and distributed testing eliminate physical and geographic boundaries. When these technologies are combined with cloud-based marketplaces to connect trial sponsors with underutilized community sites and provide those smaller sites with additional enrollment support, the patient pool expands significantly. A larger patient pool allows investigators to recruit a more diverse and representative patient population, improving data quality, avoiding delays, lowering costs, and accelerating FDA submission and approval.

The benefits of trial diversity are apparent. And while steps have been taken in the right direction, there is always more to be done. The benefits of doing so, however, are clear. Prioritizing community sites and recruiting for and implementing equitable, inclusive clinical trials can have a significant impact from both a scientific and ameliorative standpoint.

Readers Write: Are HCC Codes and RAF Scores Enough?

Are HCC Codes and RAF Scores Enough?
By Sara Pastoor, MD

Sara Pastoor, MD, MHA is director of primary care advancement for Elation Health of San Francisco, CA.

The introduction of electronic health records (EHRs) has ushered in an age of data-driven capabilities that hold great potential to alter healthcare, both as an industry and at the front lines of care delivery. EHRs have apparently disrupted everything, for better or for worse. Well known are the complaints that the EHR has inserted a wall of hardware and electrons between doctor and patient, not to mention the documentation burden that has often decreased revenue by slowing the pace of care and adding hours to a physician’s work week. Yet EHRs capture, organize, and store large volumes of health information that can now be leveraged in unprecedented ways to help payers, providers, and patients all win.

One of the most transformational results of this data and information boom in healthcare is the ability to analyze the medical complexity of a patient population and use that analysis to inform resourcing and care. Sicker patients need more and different things than healthier patients do. Historically, a primary care doctor was paid relatively the same amount of money whether caring for a patient with one chronic condition or five. Today, the data encoded into EHRs can be leveraged in specific payment arrangements to justify higher reimbursement rates for sicker patient populations, with bonuses for delivering better care through reporting on defined quality metrics.

The most common example of this involves Hierarchical Condition Categories, or HCCs, which are part of a model for risk stratification originally designed by CMS in 2004 to predict future healthcare costs for patients. Each condition category, which is based on ICD-10 codes, is combined with a set of demographics (gender/age) to assign patients a Risk Adjustment Factor or RAF score. RAF scores are based on demographics and disease burden (determined by ICD-10 codes), and are used to adjust quality and cost metrics by accounting for differences in patient complexity. Using this scoring system, payers in capitated payment arrangements can provide higher payments to primary care practices with more complex patient populations. Payers can also use these scores to determine performance-based metrics and bonuses, by identifying patients with specific expected care needs based on gender, age, and chronic condition.

In value-based payment models, RAF scores work pretty well for getting paid. However, the concept of risk adjustment and stratification carries much greater potential beyond cost estimation and reimbursement structures. It carries tremendous power to improve outcomes and decrease total cost of care. While it is critical to compensate care teams for the resources required to properly manage complex patients, more enhanced risk adjustment models based on predictive analytics enable clinical interventions that change lives.

Consider my patient, who we’ll call Albert. Albert is a 72-year-old with diabetes, hypertension, obesity, obstructive sleep apnea, and chronic venous insufficiency. His wife died after a sudden and short battle with cancer. His diabetes and other conditions were previously well controlled, but he had one prior episode of venous leg ulcer complicated by cellulitis requiring a hospital admission in the past year. Following the death of his wife, Albert started to forget to take his medications, use his CPAP device for his sleep apnea, and wear his compression stockings for his venous insufficiency. His bereavement made it difficult for him to cope, and he began to neglect his care.

Additionally, his wife had been the one to check his feet for calluses, wounds, or infections since he could not reach them,  an important daily ritual for diabetics. Without his wife to cook for him, he began dining out more often, frequently defaulting to fast food. His weight increased, his chronic conditions spiraled out of control, and he developed a diabetic foot ulcer that went unnoticed until infection had invaded the bone, eventually requiring a partial foot amputation.

Albert’s diagnoses of diabetes, hypertension, obesity, sleep apnea, and chronic venous insufficiency make up a common constellation of conditions. Every family physician in America manages many patients like Albert. Yet Albert’s ICD-10 codes, age, and gender do not alert us to his quite predictable and extremely high risk of at least one bad outcome in the very near future. Albert’s RAF score is equal to that of every other patient with his same demographics and ICD-10 profile, but Albert is a ticking time bomb. With extra support and appropriate interventions, Albert’s diabetic foot ulcer, osteomyelitis, and subsequent partial foot amputation were entirely preventable, if only we had known.

HCC codes and RAF scores are a blunt instrument for managing a population. Patient complexity and the corresponding patient needs are far more nuanced than ICD-10 codes and demographics would suggest. Determining which patients need what interventions is a delicate and sophisticated science. Furthermore, the CMS HCC/RAF model does not generalize well beyond the Medicare population, and there is a need to manage clinical risk across all types of patients and ages.

To achieve the level of insight needed in a risk adjustment model for targeted population management, the model needs to factor in a number of additional determinants. My suggestions include functional status, severity of illness, the interplay between diagnoses and treatments, historical utilization patterns, pharmaceutical costs and risks, number of subspecialists involved, and social determinants of health. This more nuanced risk stratification serves to better inform the true risk of each patient, producing actionable information clinicians can use to intervene and make a difference for those who need it most.

In Albert’s case, his combined conditions of diabetes, obesity, and chronic venous insufficiency dramatically increased his risk of chronic limb ulceration and corresponding complications due to the interplay between these three conditions. According to scientific evidence, his prior history of venous leg ulcer with infection placed him at even higher risk of repeat hospitalization for a similar event. His bereavement, a pivotal life event, predictably increased his risk of worsening severity of illness for his baseline conditions. Exacerbation of his sleep apnea due to poor CPAP compliance predictably worsened his diabetes, hypertension, and obesity, even if he didn’t struggle with medication compliance and worsening of his diet. This complex interplay of factors had a dramatic effect on Albert’s health status, not reflected in a RAF score.

Sophisticated risk adjustment models are very effective at plucking patients like Albert out of the crowd and identifying him as high risk/high need. Evidence-based clinical interventions could very likely have spared Albert both his foot and significant mental anguish, also saving his health plan a chunk of change. If we apply this illustration to thousands or even millions of patients, the potential impact to the healthcare system and more importantly to society is staggering.

I envision a world in which the EHR has an integrated advanced risk adjustment model that alerts care teams to patients like Albert. Running in the background of an EHR platform, these analytic models can identify patients who are at highest risk of a health crisis and drive actionable information into the primary care workflow where care teams can not only intervene, but also capture their work for measuring, reporting, and follow up. This is a powerful intersection between technology and the physician-patient relationship for which rudimentary HCC/RAF coding falls short.

Any patient would be grateful to avoid hospitalization or a trip to the emergency room, but the benefits of such analytic tools go much further. This is the Quadruple Aim in action, with meaningful impacts to patient experience, provider experience, outcomes, and cost of care. In a payment arrangement involving shared risk, primary care is positioned to drastically reduce total costs of care with such technology while reaping significant financial benefits for doing this work. Often, the extra clicks and associated tasks related to EHR alerts for HCC reporting feel like administrivia, lacking direct clinical impact to the patient. Alerts that directly result in meaningful clinical intervention feel like time well spent. Payers win, providers win, and patients win.

Albert had interacted with the healthcare system both while his wife was dying and after his bereavement. His history of hospitalization for venous leg ulceration sat right there in his claims data. His poor CPAP compliance was transmitted wirelessly to the DME company managing the settings on his device. The information necessary to predict Albert’s escalating risk was known, but the systems and processes were not in place to identify his risk and notify someone who could do something about it. I learned about his unfortunate health debacle when he came to me with an advanced foot ulcer, well past the window of opportunity for meaningful intervention.

I have so many memories of patients over the decades for whom the trigger(s) leading to the trip down disaster lane toward catastrophic health outcomes only became obvious in retrospect, because we didn’t know what we should have known, so we couldn’t do what we should have done. We have the technology to do better. When we start putting that technology in the hands of primary care, lives will change.

Curbside Consult with Dr. Jayne 5/9/22

I spent a good chunk of the weekend outdoors, enjoying some quality lakefront time while spring is here. Despite the copious pollen, it was still much more enjoyable than when summer hits and you’re debating whether the humidity or the mosquitoes are more oppressive. Still, when I got home, my tent needed a full wash to get the pollen out, and my quick air out took a little more time than planned. Waiting for it to dry before I could finish packing up all my camping gear gave me an opportunity to complete the Continuing Medical Education evaluations that are required for me to get credit from my recent conference attendance, and to try to wade through all the email that accumulated while I was away last week.

I also spent some time today with my extended family, who wanted me to explain what it really is that I do for work. They know I don’t see patients in person right now, but think I see patients on Zoom, which is good enough for me. They don’t really get what a CMIO does though, or what clinical informatics is, and sometimes trying to explain that is difficult. I try to give examples of the kinds of projects I work on, but I think even those are sometimes hard for people to really understand.

The one thing that usually resonates is when I talk about coaching physicians how to better use computers when they’re seeing patients. That understanding is usually accompanied by one of two stories. The most common story used to be that their doctor spends too much time looking at the computer and not at them. That’s becoming less common, which is a good thing. Now I hear a lot more stories about people’s experiences messaging their physicians through patient portals, which is good as far as portal adoption.

I actually had a conversation about that topic a couple of weeks ago with an EHR colleague. We were talking about the ways that different healthcare organizations approach the idea of encouraging patients to sign up for their patient portals. Some organizations bend over backwards to get patients to sign up. They may have staff in common areas who use a kiosk to try to get patients enrolled, or they may initiate an activation process during the rooming activities in the exam room. If organizations have highly developed process for portal utilization, they benefit from having more patients activated. This could be a financial benefit through reduction in paper billing statements, reduction in the time it takes for patients to pay bills, or reduction in staff costs due to telephone volumes for patient messages and appointment scheduling.

Other organizations however are less aggressive, and it feels like they are just hoping patients will stumble upon the patient portal and decide to sign up. A third group of organizations seems to just want to make it easy for the patients to do the workflows that a patient portal brings to the table but doesn’t necessarily want to require patients to sign up for an account.

Although I totally understand wanting to make things easy for patients, I think that approach will ultimately undermine patient adoption. Why? Because I see it in other industries. I know plenty of people who will go online every month and pay their utility bills, but won’t take the time to complete the process of signing up for automatic bill pay. Having a streamlined monthly process reinforces the customer’s action and they’re willing to do it again. But they’re not making the logical leap to understand that they could spend five minutes once and never have to go to the website again, versus spending two minutes each month for the rest of their lives paying that bill.

Not to mention that by not starting to fully embrace the use of the patient portal, they’re not able to use features such as those that might help with health promotion and disease management. They may also be missing out on the bells and whistles of being a registered user, such as being able to serve as a proxy or delegate for the accounts of children or elderly relatives, which generally aren’t available in the more freestanding workflows. Every EHR vendor handles these workflows in a slightly different way, but I see quite a few moving in the direction of “portal-lite” functionality to try to streamline patient access.

One hospital administrator I spoke with a few months ago tried to justify the fact that his organization isn’t spending any money on portal enrollment or activation efforts by saying that “our patients won’t use it because of XYZ reason, so we don’t want to waste the effort.” I think he is sorely mistaken for a couple of different reasons. First, many of the reasons that are often cited are not necessarily valid. People often think that older patients won’t be willing to use patient portals and for those tech-savvy elders, nothing is farther than the truth. If a patient is following their children or grandchildren on social media, in my experience, they are likely to be willing to use a patient portal, especially if it makes communication with their physician faster or easier.

People also think that not everyone has access to a computer or smartphone, and although that’s true, the percentage of patients who have access to those devices is climbing. Looking at 2018 data from the US Census Bureau, 92% of houses had at least one type of computer and 85% had broadband internet. Smartphones were present in 84% of households where 78% had desktops or laptops and 63% had tablets.

When thinking about the access argument, the truth is this. You don’t need to have 100% adoption to have a successful patient portal initiative. Even if you can get a percentage of your patients to enroll, and a percentage of those enrollees become active patient portal users, everyone can benefit. Patients can take advantage of self-scheduling workflows, which frees up office or call center staff. They can receive test results quicker, which often reduces phone call volumes as patients try to follow up on results. They can access visit notes, patient education materials, and care plans, which can not only reduce phone calls, but might also contribute to improved clinical outcomes.

With all that potential, it’s difficult to understand why organizations are slow to push for patient portal adoption.

What is your organization’s current patient portal strategy? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/9/22

Vital computer system has gone down more than 50 times since launching in Spokane, VA confirms

The VA confirms that Cerner was unavailable 50 times for at least some users singe going live in its Pacific Northwest sites, though the outages were not widespread.

Cerebral Receives Subpoena From Federal Prosecutors

Federal prosecutors subpoena online mental healthcare startup Cerebral as part of an investigation into potential violations of the Controlled Substances Act.

Joint Audit of the Department of Defense and the Department of Veterans Affairs Efforts to Achieve Electronic Health Record System Interoperability

An OIG joint audit of efforts by the DoD and the VA to make their Cerner systems interoperable notes that migration of legacy data into Cerner could have been more consistent, medical device integration could be improved, and user access should be limited to information needed to perform job duties.

Monday Morning Update 5/9/22

Top News

From the Allscripts earnings call:

• CEO Paul Black resigned Friday, effective immediately, saying that a new generation of leaders is needed now that the company’s focus is its Veradigm business.
• President and CFO Rick Poulton, who has been with the company for 10 years and is 56 years old, took over as CEO on Saturday.
• Black will leave the company’s board when his term expires this year.
• SVP/GM Thomas Langan has been promoted to president, while SVP/GM Leah Jones has been named CEO.
• Poulton said that selling the company’s hospital and large practice software business to Constellation Software will leave Allscripts more focused and with 5,000 fewer employees.
• With the sale, Veradigm represents 95% of Allscripts revenue, along with a “small unrelated product line” that makes up the remaining 5%.

Allscripts shares dropped 6% Friday after the earnings announcement after Thursday’s market close. They are up 22% in the past 12 months versus the Nasdaq’s 12% loss, valuing the company at $2.2 billion. They are up 68% in Paul Black’s 10-year tenure as CEO versus the Nasdaq’s 309% gain.

Reader Comments

From Door Shower: “Re: HIMSS. Recently laid off several dozen folks. As usual when that happens, many others are leaving voluntarily.” Unverified, although I’ve heard this from former employees.

From Awardee: “Re: MedTech Breakthrough awards. Who runs this?” Parent company Tech Breakthrough, which runs dozens of cloned awards sites, apparently would rather you didn’t know who’s in charge since they provide no contact information or employee names and hide their domain registration information. They are equally protective of their awards criteria and how much companies pay the marketing company to tout their “wins” in press releases. I’ll speculate from experience given the company’s lack of forthrightness – it’s a handful of India-based tech people who are banking rupees for giving companies awards whose validity is questionable but rarely actually questioned. I’m happy to update with specifics should the company be interested in providing them.

From Punjab Pete: “Re: Ascension. Lost $884 million in Q1. CIO Gerry Lewis is out, HCL outsourcing contract is axed.” The loss is verified, the other items are not, although being discussed on layoff sites.

HIStalk Announcements and Requests

One-third of poll respondents have recently struggled to pay a medical bill. Northerner slyly expresses bafflement about the question because they live in Canada.

New poll to your right or here: What action should be taken when a clinician’s mistake kills a patient?

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine & Digital Health exchange-traded fund were down 20% in the past month versus the Nasdaq’s 13% loss. They’re down 26% since the fund’s inception in July 2020 versus the Nasdaq’s 15% gain.

Sales

• A Leidos-led consortium that includes MediRecords, Coviu, and Nous Group wins a $230 million contract to implement an EHR for the Australia Defence Force. The system will replace EMIS-powered DeHS, which went live in 2014 at a cost of $94 million versus an initial budget of $16 million.
• Three-hospital Appalachian Regional Healthcare System signs a management service agreement with UNC Health, under which ARHS will implement Epic. The health system went live on Allscripts Sunrise in 2013.

People

Consulting firm Avia hires Daniel Clark, MBA, RN (Optum) as SVP of its Center for Care Transformation.

South Georgia Medical Center promotes Chuck Marshburn, MBA to CIO.

Adam Landman, MD, MHS, MS, MIS (Brigham and Women’s Hospital) joins Mass General Brigham as CIO/SVP of digital. 

Definitive Healthcare promotes Robert Musslewhite, JD to CEO as of August 1. Founder and CEO Jason Krantz, MBA will move to executive chair.

Government and Politics

An OIG joint audit of efforts by the DoD and the VA to make their Cerner systems interoperable notes that migration of legacy data into Cerner could have been more consistent, that medical device integration could be improved, and that user access should be limited to information needed to perform job duties.

The VA confirms that Cerner was unavailable 50 times for at least some users singe going live in its Pacific Northwest sites, but the outages were not widespread. The VA’s Oregon and Idaho sites will go live next in June.

Sponsor Updates

• TigerConnect publishes a report titled “It’s Time To Modernize How Health Systems Connect.”
• Arcadia partners with Datavant to accelerate biopharma research.
• Optum partners with the Dallas Cowboys to host a mental health awareness event in Frisco May 9.
• Vocera publishes a report titled “Reimagining Nursing for the Future” by Chief Nursing Officer Rhonda Collins, RNP, RN.
• Quil publishes a new case study, “Penn Medicine Improves Discharge to Home Rates, Expands Partnership Systemwide with the Help of Quil.”
• TMC awards Talkdesk’s AI Trainer with its 2022 Customer Product of the Year award.
• Interbit Data will participate on MUSE in Dallas the week of May 15.
• TigerConnect sponsors the Nurses at the Heart of Healthcare Contest to recognize nursing professionals who have shown an unwavering commitment to their profession.
• TriNetX appoints Launch Therapeutics CEO Anshul Thakral to its Board of Directors.
• Healthcare Growth Partners publishes research titled “Seeking Balance in the Hyperactive Mental Health Tech Market.”
• Kyruus ProviderMatch for Consumers is named “Best Patient Registration & Scheduling Solution” by an independent marketing group.
• Twistle publishes a new case study featuring Ashley Clinic, “Controlling Blood Pressure with Remote Physiologic Monitoring.”
• WebPT has been certified as a Great Place to Work for 2022.
• Relatient, Change Healthcare, Experian Health, Myndshft, Well Health, and Vyne Medical will exhibit at NAHAM 2022 May 10-13 in San Diego.
• West Monroe hires Rissa Reddan (Equifax) as chief marketing officer.
• Wolters Kluwer Health will exhibit at the RISE Risk Adjustment Forum May 9-11 in Chicago.
• Zen Healthcare IT’s Gemini platform receives HITRUST CSF r2 Certification.

Blog Posts

• “Clickbusters” can bust more than clicks (Nordic)
• 5 Tips for Hiring and Retaining Top Talent (Olive)
• The Top 5 Reasons Why Hospitals Should Optimize Patient Engagement (PatientBond)
• The Great Resignation: Key Takeaways (Pivot Point Consulting)
• Focus on Access Management for Safety in Healthcare (Symplr)
• 10 Years of MSSP: 2012 Fears Versus 2022 Realities (Part 2 of 2) (Premier)
• Three Qualities to Consider When Selecting a Healthcare Technology Partner (Protenus)
• Nurses are Calling for Innovation. Let’s Listen. (Vocera)
• Takeaways from the MTMI breast cancer risk assessment webinar (Volpara Health)
• It’s All Up from Here: Advancing Our Profession Through Next-Level Data Intelligence (WebPT)

Contacts

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

Morning Headlines 5/6/22

Allscripts Announces First Quarter of 2022 Results

Allscripts reports an uptick in Q1 revenue and that CEO Paul Black will step down.

Office overseeing EHR interoperability between DoD, VA not having ‘active role’ in rollout

Lack of oversight and planning by the Federal EHR Modernization Program Office has hampered interoperability between the DoD and VA’s new Cerner systems, according to a new joint report from the DoD and VA inspectors general.

OptimizeRx Reports First Quarter 2022 Financial Results, Revenue Up 22%, Successfully Completes EvinceMed Acquisition

OptimizeRx reports Q1 results: revenue up 22%, adjusted EPS $0.01 vs. $0.04, beating revenue expectations and meeting those for earnings.

News 5/6/22

Top News

Allscripts reports Q1 results: revenue up 7%, adjusted EPS $0.13 vs. $0.08. Expectations are muddied, as the company has carved out Veradigms’s financials separately.

CEO Paul Black will reportedly step down, with President Rick Poulton taking on the role effective immediately.

Allscripts finalized the sale of its hospital and large practice software business to Constellation Software subsidiary N. Harris earlier this week.

Webinars

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

Acquisitions, Funding, Business, and Stock

OptimizeRx reports Q1 results: revenue up 22%, adjusted EPS $0.01 vs. $0.04, beating revenue expectations and meeting those for earnings.

Sales

• Oklahoma’s MyHealth HIE selects Orion Health’s Amadeus population health management software, and consulting services from HealthTech Solutions.
• Cardiac monitoring vendor MediLynx selects EHR integration capabilities from Redox.
• The Capital Region in Denmark will implement cloud-based enterprise imaging from Sectra at its hospitals.

People

South Georgia Medical Center promotes Chuck Marshburn to CIO and HIPAA privacy officer.

Announcements and Implementations

HCTec announces GA of staffing and consulting support for Epic Hyperdrive.

Magellan Federal integrates NeuroFlow’s digital behavioral healthcare assessment, triage, and management capabilities into its Military & Family Life Counseling program.

Mankato Clinic will implement virtual care software and services from Bluestream Health at its 13 facilities in Minnesota.

Other

Pivot Point Consulting’s latest report on healthcare IT trends suggests that hospital leaders should:

• Adjust staffing models to accommodate hybrid and remote workers.
• Evaluate supply chains and legacy applications in light of cyber risks from third-party risk management and managed services vendors.
• Carefully evaluate proposed remote patient monitoring technologies and services.
• Prepare to work with TEFCA-enabled Qualified Health Information Networks.
• Consider the ways in which ERP and business systems can be successfully adopted to enhance workflow efficiencies.

Sponsor Updates

• Myndshft joins enterprise automation software company UiPath’s Tech Alliance Program.
• Lyniate publishes a new case study, “Clinify Health helps improve financial stability for FQHCs with Lyniate Envoy.”
• Meditech recaps its virtual Home Care Symposium, which brought 275 attendees together to network and collaborate on strategies for the future.
• Nuance joins Athenahealth’s Marketplace to broaden physician access to the Nuance Dragon Ambient EXperience for automated clinical documentation.
• HCTec celebrates the opening of its expanded office space in Winston-Salem, NC.
• EClinicalWorks publishes a new customer success story featuring Innova Primary Care, “How Healow Payment Services Transforms Collections.”
• CloudWave will implement Tausight’s situational PHI awareness platform and deliver turnkey PHI monitoring, management, and response to healthcare providers.
• Cerner will offer its customers access to Akasa’s AI-based Unified Automation platform for healthcare revenue cycles.

The following HIStalk sponsors have won MedTech Breakthrough Awards:

• WebPT – Best patient registration and scheduling solution
• Kyruus – Best online search and scheduling solution
• GHX – Compliance management innovation
• Nym – Health administration innovation
• Talkdesk – Best patient relationship management solution
• Elsevier – Best patient education solution
• LexisNexis Risk Solutions – Best HIE solution
• Fortified Health Security – Best overall healthcare cybersecurity company
• Current Health – Best hospital technology implementation

Blog Posts

• Reduce Patient Leakage with More Care Options, Part 2 (EVisit)
• Better claims management: faster patient payments and reduced denials (Experian Health)
• How CISOs Can Guard Against Evolving Physical and Digital Corporate Security Threats (Everbridge)
• 10 reasons why hackers think your HDO is an easy target (Imprivata)
• How to Improve Patient Experience with Data Management (InterSystems)
• Data normalization: Working toward a common clinical terminology (Intelligent Medical Objects)
• 4 Key Steps to Creating a Holistic Find Care Experience (Kyruus)
• 4 Ways to Measure Chatbot ROI (Loyal)
• Healthcare Interoperability – How can Medhost help you comply? (Medhost)
• Physical Therapy Core Values for PTs & PTAs at Your Practice (MWTherapy)
• Why Automation is the Key to Fixing Prior Authorization (Myndshft)
• A Look at Current Unmasking Initiatives in OccMed (Net Health)
• How interoperability can support value-based care (Nordic)

Contacts

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

EPtalk by Dr. Jayne 5/5/22

Those that follow me on Twitter know what I’ve been doing this week as I traveled to the rolling hillsides of Verona, Wisconsin. Epic’s Expert User Group (XGM) meeting was in its second week, with a heavy focus on clinical topics. It was great to catch up with some old friends, most of whom I worked with on other EHR systems across the last two decades. Each hospital and health system has certainly had its own healthcare technology journey, but it’s clear that for quite a few of them, all roads have led to Epic.

I’ve attended a variety of user groups across most of the major vendors and there are quite a few elements that set Epic apart as far as meetings. Rather than having to rely on hotels or conference and convention centers for meeting space, Epic’s purpose-built facility makes things incredibly easy for attendees. Presentation rooms are interestingly named, amusingly decorated, and full of light – unlike the cavernous spaces divided by portable walls that many of us are used to when we go to meetings. The meeting area also featured booths from various local vendors selling various kinds of cheeses, chocolates, locally produced soaps, and more. I enjoyed seeing everything Wisconsin has to offer and from the number of sales transactions, it appears others did as well.

Another thing that sets Epic apart is its outstanding culinary team. I’ve had plenty of questionable meals at conferences, but the menu selections at XGM were truly over the top. There’s a definite “farm-to-table” feel with lots of healthy offerings. Goat cheese and asparagus options appeared at several meals, which made me very happy, as I like them but don’t often cook them. Attendees were even able to download a 95-page document with recipes in the event they wanted to replicate the experience at home. I’ll definitely be availing myself of the recipe for scones.

Many attendees toured the campus, although rain on Tuesday put a small dent in that. It’s been great meeting other physicians involved in clinical informatics work, especially in disciplines that I haven’t worked in for a while. I enjoyed learning about different groups’ approaches to trauma-informed care and how to use EHR tools to better support patients. One of my favorite presentations was by UCLA Health, which has been using Natural Language Processing to identify patient portal messages that contain high-risk topics. It allows clinical care teams to address those messages more quickly, which hopefully will lead to improved outcomes. The team acknowledged the impact that the COVID pandemic has had on its work, and I know there was a lot of sympathy from audience members whose own projects may have been sidetracked or even canceled as a result of changes in organizational priorities.

It’s always a challenge to balance what’s going on at your day job with attending a conference, and I had a couple of conversations with physician informaticists who were reacting to the idea of a Supreme Court decision overturning Roe v. Wade. My OB/GYN colleagues are noting increased patient demand for appointments to place long-acting contraceptive devices as well as those to discuss prescriptions for emergency contraceptive medications. With several states having laws in place that would go into effect immediately upon the event of an overturn, I understand their desire to be proactive. There have been requests to alter physician schedules to add procedure slots as well as to create outbound patient portal messaging to try to reduce the number of phone calls the offices are receiving. Life as a clinical informaticist is certainly never dull.

The COVID-19 pandemic changed the landscape for virtual contraceptive services, which were offered by the majority of clinics surveyed for a recent article. Pre-pandemic, only 11% of those surveyed offered telehealth consultations for contraception, with the number rising to 79% after March 2020. Apparently, 22% of those surveyed had drive-through contraceptive clinics. Although I don’t recall hearing about any of those in my area, it’s a great idea. I found it interesting that 20% of people closed their in-person clinics and only offered services via telehealth. The study had a relatively small sample size of around 900 respondents. It will be interesting to see what happens to this landscape in coming months.

In speaking with other attendees, behavioral health continues to be a hot topic. There are too few providers to meet demand and organizations are looking to creative offerings such as teletherapy and self-service interventions for patients. Staffing challenges were also a common theme, and organizations are looking to use pre-visit questionnaires to help gather data prior to the visit so that the patient rooming process is more efficient. Automated alerts to let patients know when their care teams were running late are gaining traction. Many of the solutions presented by clients focused on shifting various tasks from the staff to patients. Although those moves can definitely support patient engagement, they’re also ways to help mitigate staff burnout. Many organizations are still struggling to hire office-based nurses, medical assistants, care coordinators, and patient care technicians, so they’re looking for whatever efficiency boosts they can find. It sounds like there are a lot of optimization projects going on, with hospitals trying to fit that work in before a potential next pandemic wave.

On Wednesday, which happened to also be Star Wars Day, a couple of presenters included Star Wars references in their slide decks, and I spotted several attendees in costume. I closed out my meeting experience with a trip to “Xtra Hour,” which was advertised as a social event for food and fun at the end of the day. The event featured a variety of food and drink, including a lovely crab and leek appetizer and sparkly galactic-themed lemonade. I heard the mini cupcakes were good as well as the mini meringue desserts. Attendees had the chance to take part in several activities including craft projects and giveaways, and of course there was plenty of good old-fashioned socializing. Then it was back to the hotel to put my feet up and to pack so I can head home in the morning. Overall, it was a great experience and I’m heading back with a notebook full of ideas and thoughts to make life better for my end users and their patients. I was also happy to be able to have in-person encounters with many of the people I work with regularly. Building relationships is always one of my favorite parts of these events.

What is your favorite part of a user group meeting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/5/22

Offor Health Completes Series A Round With Additional $9 Million Led by AXA Venture Partners

Offor Health, which specializes in providing mobile surgical services to in-office settings, raises $9 million in a Series A funding round.

Workflow automation solution for post-acute care Element5 closes $30M in Series B round of funding

Post-acute care workflow automation vendor Element5 raises $30 million in a Series B funding round, bringing its total raised to $45 million.

Cruces-based telehealth company Electronic Caregiver to add 770 jobs

Remote patient monitoring company Electronic Caregiver will hire 770 employees as it expands its headquarters in New Mexico with the addition of a clinical triage center.

HIStalk Interviews Mariann Yeager, CEO, The Sequoia Project

Mariann Yeager is CEO of The Sequoia Project of Vienna, VA.

Tell me about yourself and the organization.

I’ve been in health IT virtually my entire career. I got my start years ago working for an insurance company, then a clearinghouse, and have been in health IT ever since. I got into the interoperability space, working with the ONC on the Nationwide Health Information Network project, which led to the formation of this particular project 10 years ago. We were formed as a non-profit, public-private collaborative. We are solely focused on advancing interoperability for the public good and working in collaboration with government to offset the burden of what they’re trying to accomplish.

Is the lack of interoperability a technical problem or a business problem?

All of the above. There are policy, business, and technical issues that impede the ability for information to flow seamlessly. That’s where we focus our energies at The Sequoia Project, identifying the issues that are impeding progress and systematically addressing them one at a time.

What other industries provide a model for competing organizations exchanging information about their shared customers?

Certainly we can learn a lot from financial services, telecom, and banking. In fact, as we were exploring and preparing to launch Carequality in 2014, we researched how things operate in the ATM and ACH world, where they have a non-profit that brings together different stakeholders to develop rules of the road so that ACH networks interconnect. Carequality was modeled after that type of activity. There’s a lot we can learn, but in some ways, what we’re dealing with is a far more complicated transaction than a banking transaction, so there are a lot more issues to unpack.

Arguments have been made that healthcare participants should be paid for sharing data instead of being penalized when they don’t. Is the sharing model yet to be determined?

From where we sit, there needs to be a baseline of technical and policy capabilities in place to interconnect our ecosystem.Then there needs to be a value to exchange and then an impetus to exchange. The value to the exchange usually comes from the value of the information and whether it offsets some administrative burden. Is there a return on investment, for instance, or does it somehow contribute to some other good? That’s the first thing to look at and explore — the value of exchange.

Then the impetus to exchange is, how do you get people to use the capabilities that exist? Again, it’s really derived from value. You can have opportunities to have better information more readily accessible and that makes the clinician’s life easier, makes supporting value-based arrangements easier. The impetus to change can also come from governmental mandates. What we are seeing in our space now is a combination of all the above, which creates an exciting opportunity to advance the ball within interoperability, because the stars are aligning in terms of all these things coming together.

How will ONC’s information blocking review work under a complaint-based system where it’s often a big health system that isn’t sharing patient data?

We’ve seen tremendous progress in healthcare organizations interconnecting for treatment purposes, of course, starting with health systems. There’s a tremendous volume of information being exchanged between health systems and now increasingly across the continuum of care. 

We have to take into account the maturity of the platforms that these other care settings are using to support their clinical environment, and then the other actors that have a need for health information but that aren’t even participating in the network. It makes it a lot more difficult if you’re trying to approach point-to-point arrangements versus if you’re a public health agency, a health plan, or a small physician practice. If you’re able to connect to a health information network, that is the mechanism that allows you to access information. Then of course if that network interconnects with other networks like to Carequality or an ONC-endorsed TEFCA framework, that’s where we’re going to see the seamlessness. I think it’s a reflection of, in part, the maturation of those capabilities, the ability to participate in networks and along that life cycle. 

Then we can’t even begin to speculate how ONC might and OIG may be approaching compliance. With respect to the different actors, health information networks, health IT developers, healthcare provider organizations, et cetera, that really remains to be seen from where we sit. It boils down the very practical issues that are impeding exchange — different interpretations of law, different interpretations of policy, different interpretations of what is even treatment-based exchange, care coordination treatment. We’re getting greater clarity around that. For us, it’s much more nuanced

What efforts are you seeing to connect public health to the healthcare system?

It’s pretty ad hoc right now, for the most part. Everyone realized that in the midst of a pandemic is not the time to try to create an interconnected health IT ecosystem that the public health is plugged into. But there are tremendous opportunities to leverage existing infrastructure for that purpose. Naturally there are regional statewide HIEs and others that are doing interesting things to support public health and make it easier for public health agencies to get the information that they need.

Electronic case reporting is getting significant uptake and being supported both within nationwide networks and with others across and between networks. That is just an example that if you have a discrete use case and you have a trust framework in which to support it, that capability exists. This is an area where we think that TEFCA is going to play an important role in advancing this in a much more robust way for more public health capabilities.

Can you describe in simple terms the impact that TEFCA and Qualified Health Information Networks might have on consumers and providers?

The 21st Century Cures Act was passed into law in December 2016. It directed ONC to develop and support a Trusted Exchange Framework and Common Agreement, TEFCA, to support the exchange of information between different, disparate health information networks. ONC has been working since then to develop key elements to enable that to occur. They were given the ability to work with a private sector organization to help them implement the different components of TEFCA to operationalize it. The Sequoia Project was selected to serve as that private sector organization, an official designation as being a Recognized Coordinating Entity. We are working with ONC to develop the agreements, the implementation guides, and the onboarding process that would enable networks that want to receive special government endorsed designation as a TEFCA Qualified Health Information Network, or QHIN, where we would work to facilitate that process and do the onboarding and designation for those that comply.

How do the various elements of trust fit in with the ability to exchange information, including one provider not trusting another’s data?

It’s a policy issue, and there is a technical element and workflow element as well. The idea of having trust agreements and trust frameworks is so that a participant — a healthcare organization or participant or actor in one network — can rely on the information they’re getting from someone else. That it comes from a trusted source, that they’re abiding by the same rules of the road, and that the information is only going to be requested in accordance with certain rules of engagement. It will be appropriately protected. That is very foundational before someone would even be willing to share information at all.

The other part of that is, can you trust the information itself? Does the information have value? Is it semantically valid? We are doing a lot of work on that at The Sequoia Project through our data usability work group, which includes a group of subject matter experts, guests from across many different stakeholder groups, to try to define in a more clear way how data should be codified to improve the value and meaning of the information when it’s exchanged.

Is a national patient identifier essential to the process?

The issue around the national patient identifier is multifaceted. Some believe that it would be the linchpin to solving interoperability, while others say that it really has value for a small portion of identities that we can’t match through other means. At Sequoia, we tend to be practically oriented about what can we do today to improve matched results and increase it over time. We publish white papers to that effect and refresh and update white papers we published years ago. The use of secondary identifiers, and adding that onto the other identity traits used for matching, can be quite effective. We think that there’s a lot of value in continuing to look at methodologies like that. We tend to meet the market where it is and set our sights on what we can do to incrementally improve progress over time. A unique health identifier has its place, but there are also things we can do today to make tremendous progress. We look at that very carefully,

People often misunderstand HIPAA or misrepresent it to support what they want to do. Is the 1990s-era rule a barrier to what you would like to accomplish?

In some cases, HIPAA is very much an enabler, because it is a standard for privacy and security that we can leverage and it is well understood and established. In other cases, HIPAA predated most of the digitization of healthcare, and there are aspects of it that are, as you said, misunderstood or misinterpreted. Maybe it is an area that needs further clarification.

A good example that we saw in the pandemic was that healthcare organizations were reluctant to share summaries of patient records with public health agencies. They worried about exceeding minimum necessary. OCR issued guidance clarifying that if you receive a request from a public health official, you can trust that it’s for the information that they need. It was still an impediment that was more of a policy interpretation and a risk tolerance. It was more of an impediment in terms of interpretation and understanding. Trying to get that kind of clarity in the midst of a pandemic is quite challenging.

People who read about FHIR and interoperability APIs may think we’ve solved the problem, but many of us still have personal experience where a new provider is starting with a blank slate. Is consumer education needed to set expectations for information sharing and blocking in a complaint-based system?

FHIR, APIs, and the emerging role that apps will play in enabling consumers to access their health information are all tools in the toolkit. If you think about it from the perspective of individual access, you have obligations now to share information with individuals. It’s an imperative. We are working on how to operationalize that.

A good example of that is the work that we are doing with the ONC on TEFCA and those organizations that participate in TEFCA, others as a QHIN itself or as a participant or someone connected to QHIN itself. There’s an obligation that if someone requests their information and if you have information about that person, you must share it unless you are not permitted by law to do so, or somehow breach privacy or security.

We look at not so much information blocking as a compliance paradigm, which it certainly is, but if you turn it on its head, it’s an information exchange paradigm that TEFCA and other activities can reinforce. The more we address impediments to information exchange, the more we get down to the brass tacks of how to make this work seamlessly. Individual access is an excellent example, because we can support that on a wide scale basis today using the very standards and protocols that have existed for a long time and using new standards and protocols such as FHIR. The issues often boil down to policy. That’s really what we’re trying to unpack with respect to our work on TEFCA.

ADT notification is a lightly heralded success that took a lot of effort. Are you seeing significant uptake?

ADT notification is a great example of capabilities that were born out of market need and demand organically. You see so many health information networks supporting those capabilities, and have that reflected in regulation as well, as a way to demonstrate meeting certain measures with CMS. It’s an exciting paradigm to witness. We hope that the work that we foster here in the private sector can be pointed to in other ways. That’s why we work very much at Sequoia with boots on the ground, trying to resolve issues that have practical implication and get some traction that hopefully reinforces and supports policy goals.

What will be the most important interoperability issue over the next two or three years?

I would like to see us move beyond the sharing of information for treatment purposes. We’ve seen tremendous progress and very much take pride in what we, as a collective industry, have done in that regard. We can expand that to support other use cases, such as the exchange of information for payment, for healthcare operations, to individuals, and for public health purposes. I am very positive about our ability to reach that. We have good momentum. We are getting good traction. I think we will start to see some real progress in that respect.

Do you have any final thoughts?

I would like to reflect on the past 10 years and our journey here at Sequoia. We started in back in 2012 with the idea that there would be a need for an organization like us — a non-profit, public good-oriented organization; public-private; working to advance the ball on interoperability by solving practically oriented issues. We have seen the ability to make strides not by going it alone, but by having a broader community of stakeholders working with us side by side. We attribute the progress and our ability to have incubated and launched these initiatives and the work we’ve done with interoperability matters in TEFCA to the tremendous support that we’ve had from stakeholders. I just wanted to acknowledge and be thankful of that.

Morning Headlines 5/4/22

Cerner Reports Fourth Quarter and Full Year 2021 Results

Cerner reports Q1 results: revenue up 4%, adjusted EPS $0.93 versus $0.78, meeting earnings expectations but falling short on revenue.

VA secretary urges EHR rollout to continue, but ‘very concerned’ about system outages

VA Secretary Denis McDonough says the agency will continue rolling out its new Cerner software despite five recent outages that have caused some lawmakers to call for a halt to implementations.

American College of Physicians and the American Telemedicine Association Collaborate on New Digital Health Assessment Framework

The American College of Physicians and the American Telemedicine Association will develop a framework for assessing digital health technologies that are used by providers and consumers.

News 5/4/22

Top News

Allscripts closes the sale of its hospital and large practice software business to Constellation Software’s subsidiary N. Harris.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Global Healthcare Exchange. Founded in 2000, GHX pioneered healthcare’s largest cloud-based supply chain network, which today connects tens of thousands of healthcare organizations across the globe. The network represents healthcare providers operating more than 80% of licensed beds in the US and suppliers representing more than 85% of the medical-surgical products used in healthcare delivery. With the support of GHX, healthcare organizations have removed billions of dollars of wasteful healthcare spend. Over the last two decades, GHX has continued innovating alongside a passionate community of healthcare providers, suppliers, distributors, and other industry stakeholders, all united around a common purpose: to simplify the patient-centered business of healthcare to improve outcomes. The company’s passion for uniting the best of healthcare is driven by a powerful vision: create a viable and sustainable future for healthcare by arming organizations with the data, insights, and technology they need to thrive in healthcare’s value-based future, where patients are at the heart of every decision. GHX believes that by empowering organizations to move beyond process efficiency, and toward efficiency of outcomes, organizations will thrive and the vision of a viable and sustainable future for healthcare will become a reality. Thanks to GHX for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner reports Q1 results: revenue up 4%, adjusted EPS $0.93 versus $0.78, meeting earnings expectations but falling short on revenue.

Configo Health, a startup that has developed benchmarking analytics for pediatric hospitals, raises $2 million in a seed funding round.

Plug-and-play virtual care software developer Capable Health raises $6 million in seed funding. Its technology allows developers to launch digital clinics.

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $136 million.

Online pharmacy Truepill stops filling Adderall and Vyanse prescriptions as online mental health companies such as Cerebral and Don Health raise concerns about overprescribing. Major drug chains such as Walmart and CVS have also reportedly delayed or declined to fill such prescriptions.

The American College of Physicians and the American Telemedicine Association will develop a framework for assessing digital health technologies that are used by providers and consumers. The US-focused framework covers privacy and security, clinical assurance and safety, and usability.

Sales

• Rochester Regional Health (NY) will incorporate TytoCare’s telemedicine software and hardware into its virtual care services.
• University of Michigan Health will use analytics from Loopback Analytics to improve its specialty pharmacy program.

People

OncoHealth promotes Jennifer Haas to chief marketing officer.

Divurgent names Ed Marx (The HCI Group) CEO. He replaces founder Colin Konschak, who will become executive chairman.

Lynne Nowak, MD (Evernorth) joins Lark Health as chief medical officer.

IKS Health hires Ben Crocker, MD (Massachusetts General Hospital) as SVP of care design and innovation.

Stan Opstad, MBA (Inovalon) joins Zipari as chief product officer.

Announcements and Implementations

Audubon County Memorial Hospital & Clinics (IA) staff will implement Epic this week.

Jefferson Radiology goes live on Philips Collaboration Live for diagnostic tele-ultrasound, allowing remote radiologists to connect virtually with patients during their imaging appointments to provide a diagnosis, answer questions, or request additional imaging from the sonographer.

Consumer-focused healthcare wearables company Withings launches enterprise remote patient monitoring devices and software for patients and providers.

Personal ECG app vendor AliveCor launches KardiaComplete, a remote personal monitoring and virtual cardiologist service for people with hypertension and arrhythmias, sold through employers and payers.

Government and Politics

Winn Army Community Hospital at Fort Stewart in Georgia will go live on Cerner next month as part of the DoD’s continued wave of MHS Genesis roll-outs.

VA Secretary Denis McDonough says the agency will continue rolling out its new Cerner software despite five recent outages that have caused some lawmakers to call for a halt to implementations. The VA’s Central Ohio Healthcare System in Columbus went live on the EHR over the weekend. McDonough said he is “very concerned about the execution of the program to date” and added that the first of the downtimes was so “egregious” that Cerner CEO David Feinberg, MD, MDA issued a signed apology.

Privacy and Security

Virtual chronic care management and remote patient monitoring startup MyNurse notifies users of a March data breach, adding that it will cease operations at the end of the month for unrelated reasons.

Good Samaritan Medical Center Director Amy Travland reminds staff to print their names and avoid abbreviations when paper charting during downtime, referring to a cybersecurity incident last week. Good Samaritan was one of two Tenet Healthcare facilities in Florida that took systems offline as a result of the breach.

Other

Cardiologists express concern that tens of millions of consumer devices that can issue atrial fibrillation warnings will consume doctor time and healthcare expense to confirm or rule out a diagnosis, all for uncertain benefit. Symptom-free patients will have medical-grade monitors attached for days and then potentially have expensive anticoagulants prescribed that can cause side effects. One cardiologist said that tech companies introduced such alerting “because they could” and said that doctors are trying to catch up to the “test doctors didn’t order.”

Mozilla finds that of 32 mental health and prayer apps it reviewed, 28 raise strong data management concerns and 25 fail to meet minimum security standards. Mozilla’s lead privacy expert called the apps “exceptionally creepy” and that the companies that offer them are “negligent and craven.” The biggest offers named are Better Help, Youper, Woebot, Better Stop Suicide, Pray.com, and Talkspace.

Authorities in Venezuela arrest Jose Lopez for working at several healthcare facilities with fake medical credentials. His crime came to light after several women became pregnant after he had supposedly implanted them with subdermal contraceptive coils. He had, in fact, implanted lollipop sticks.

Sponsor Updates

• AdvancedMD Director of Sales Operations Carla Huggard wins a Utah Women in Sales Award.
• Actium Health publishes a new report, “State of Patient Engagement in 2022.”
• Baker Tilly will sponsor the Maryland HIMSS 10^th Annual Golf Tournament May 9 in Valley.
• Bamboo Health will exhibit at the Skilled Nursing Clinical Executive Conference May 5 in Chicago.
• CHIME posts a podcast titled “Filling the Talent Pipeline” with guest Geoff Blanding, EVP of Optimum Healthcare IT.
• Cerner releases a new podcast, “Combatting clinician burnout.”
• GHX names 80 provider and supplier organizations to its Millennium Club that have achieved the highest levels of supply chain automation through the GHX Exchange.
• CTG will sponsor the AWS Summit Atlanta May 18-19.
• Divurgent names Andrew Wells (McCormack Plastic Surgery) senior director of business development.
• Change Healthcare will work with Luma Health to develop new patient engagement solutions that unify clinical, operational, and financial touchpoints.
• The Iowa Hospital Association will offer its members access to ChartSpan’s chronic care management services.
• Experian Health, PatientKeeper, ManpowerGroup, CereCore, Change Healthcare, CloudWave, Dimensional Insight, Ellkay, Elsevier, FDB, Healthcare Triangle, Intelligent Medical Objects, Interbit Data, Intrado, Nuance, OBIX Perinatal Data Systems by Clinical Computer Systems, Sphere, Tegria, and Meditech will exhibit at the MUSE Inspire Conference May 15-18 in Dallas.

Blog Posts

• Three Pillars of Single-Path Coding (AGS Health)
• More meaningful care through data (Arcadia)
• Healthcare Technology Can Drive the Fourth Industrial Revolution (Ascom)
• How Azara DRVS Supports Behavioral Health Services (Azara Healthcare)
• GHX Announces Upcoming GHX Summit 2022 Highlights (GHX)
• Leadership – What Does it Really Mean? (CHIME)
• Tips to Effectively Fund Your Enterprise Cyber Risk Management Program (ECRM) (Clearwater)
• The Link Between EHR Satisfaction and Clinician Burnout (Dimensional Insight)
• Managing Post-Acute Care: A Critical Success Factor for ACOs (Dina)
• Insights and Takeaways from the 2022 Internet 2.0 Conference (Divurgent)
• Who are the 29 Million Americans Who Use Health Centers? (EClinicalWorks)

Contacts

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

Morning Headlines 5/3/22

Virtual care enabler Capable raises $6 million

Capable Health, developer of plug-and-play virtual care software, raises $6 million in seed funding.

Guidewell and Highmark Ventures Lead $35 Million Funding Round in Kidney Health Leader Healthmap Solutions

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $135.6 million.

Allscripts Closes Sale of Hospital and Large Physician Practices Business to Constellation Software

Allscripts finalizes the sale of its hospital and large physician practices business to Harris parent company Constellation Software for up to $700 million in cash.

Health startup MyNurse to shut down after data breach exposed health records

Virtual chronic care management and remote patient monitoring startup MyNurse announces it will shut down alongside its notice to users of a March data breach.

Curbside Consult with Dr. Jayne 5/2/22

Today is truly a cleanup day. I’m plowing through 2,300 unread emails. Some days you just can’t make things up with the stories that are out there.

The US Department of Justice announces that a Long Island cardiologist has been charged with crimes related to a COVID-19 healthcare fraud enforcement action. He is alleged to have defrauded Medicare and Medicaid of more than $1.3 million in payments related to COVID-19 testing as he submitted claims to those payers for office visits that were not performed in conjunction with COVID-19 testing. The defendant’s practice had mobile testing sites across Long Island, and apparently some of the billed office visits occurred when the defendant wasn’t even in the state. The prosecution is part of a larger effort by the Department of Justice to crack down on those exploiting the ongoing public health emergency. Criminal charges have been filed against at least 21 defendants for COVID-related healthcare fraud and total nearly $150 million in false claims. The overall Medicare Fraud Strike Force, which was formed in 2007, has gone after more than 4,200 defendants who fraudulently billed Medicare for over $19 billion.

Just a little over a month ago, medical students across the US learned where they’d be doing their training as a result of the National Resident Matching Program. This article about a participant who didn’t match caught my eye. Travis Hughes completed both MD and PhD degrees at Harvard and had a lengthy curriculum vitae with numerous publications and four patents, yet still didn’t match into his desired field of dermatology. More than seven percent of fourth-year medical students in the US failed to match, so he wasn’t alone, although his qualifications likely make him unique. Rather than lament his situation, Hughes used the experience as the push he needed to move towards a career in healthcare technology.

I’m often contacted by people in similar situations looking for advice on moving into healthcare technology or clinical informatics. Not only do unmatched graduates reach out, but those who are in their last year of medical school and who have decided that clinical practice is not for them.

I’m supportive of people finding their bliss in medical careers that don’t involve seeing patients, but have some advice for individuals in this situation. First, just because you graduated from medical school doesn’t mean that you understand what it takes to become a board-certified practicing physician. There’s a lot that happens during the three to seven years of residency training and no amount of reading about it or having friends who are in residency is going to help you become equivalent.

Second, if you’re going to try to find solutions for practicing physicians, you need to understand what happens once you are in practice. Learn what a RVU is or how physician compensation is influenced by patient satisfaction scores and clinical quality metrics. Learn how hard it is to keep a medical practice staffed to a level that provides high quality care but runs as cheaply as corporate employers require.

Third, please don’t talk to practicing physicians like you’ve been in their shoes. Over the past two years, I’ve had many patronizing encounters with physicians who have gone the start-up route. I don’t want to hear about how you dropped out of a surgical subspecialty residency the year before graduation, yet you think you understand what it feels like to be a practicing family physician or an emergency physician dealing with COVID. Sure, you can talk about how you understand the market forces and the pressures we’re under, but you certainly haven’t been there or done that. Also don’t talk about patients like they’re numbers or widgets, because those of us who really treasure the patient/physician relationship aren’t likely to warm to that strategy. If you want to impress us, make sure we feel like you understand that those patients are someone’s mother, grandfather, sister, or child.

Finally, if you’ve decided to take a different path in your career, get some training. If you want to go into clinical informatics, maybe you should join the American Medical Informatics Association. Consider taking one of the 10×10 courses that they offer in partnership with Oregon Health & Science University. Do a fellowship in clinical informatics. Don’t post on physician-focused Facebook groups that you’ve just decided to go into informatics and ask how to get jobs with no experience and no training. Definitely don’t demand that people call you and give you career guidance because you’re too lazy to spend some time on the internet figuring out what it takes to be qualified in the field.

I do wish good luck for all those who are contemplating career changes or who did not match. Much work is ahead and it’s a difficult road. Hopefully, this advice might provide a small amount of insight for those walking it.

I’m doing a fair amount of work with various vendors and have been invited to participate in multiple vendor user group meetings for the upcoming season. While some vendors are going back to their tried-and-true pre-COVID meeting plans, others are using the opportunity to make changes to format and desired attendee profiles. There have been a few recent in-person meetings since HIMSS, and by report, the attendance has been less than previous years. Epic kicked off its XGM Expert Group Meetings last week in Wisconsin and they continue through the end of this week. The American Telemedicine Association meeting is also happening this week in Boston. I’d love to hear from attendees as far as their boots on the ground experiences as well from others who have decided not to attend conferences right now. At least one major health system that I interact with has continued to restrict business travel for the remainder of 2022. They’re not saying employees can’t travel, they’re just refusing to pay for any of it, blaming it on COVID.

Although various states, jurisdictions, and businesses have collectively decided that COVID-19 is over, it’s starting to make a return in my area. Several schools are hitting the thresholds for which students and teachers have to resume masking. I’ve got a couple of flights this week, and despite the airlines’ movement to a mask optional arrangement, I’ll be sporting a KN-95. Even though the COVID infections that most people are getting now are relatively mild, we’re starting to see much more long-term data that shows that even people with mild infections are at higher risk for cardiovascular and other complications. I’ve dodged it so far and am hoping my luck holds.

From a patient care perspective, it’s the school and sports physical season as young people get ready to go away to camps or to prepare for fall sports. Our state has instituted a special process for return to play in youth who have had COVID, and we’re finding quite a few athletes who aren’t as healthy as they thought they were before we started asking some very pointed questions.

Is COVID-19 still playing a role in your habits or travel plans? Is your employer still requiring any mitigation strategies or is everyone back to the office as usual? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Carina Edwards, CEO, Quil Health

Carina Edwards, MBA is CEO of Quil Health of Philadelphia, PA.

Tell me about yourself and the company.

I have spent more than 25 years in healthcare technology. I have dedicated my focus and career on delivering experiences that delight customers and drive value and success in digital health. It has been fun being the CEO from the inception of Quil.

Quil is a digital health joint venture between Comcast NBCUniversal and Independence Blue Cross. We help people organize and navigate their health lives in partnership with their providers, their health plans, and their loved ones. We have two solutions. Quil Engage is the care engagement platform that delivers intelligently individualized care journeys to support patients during every step of their care, prescribed by providers and sold to provider organizations. We now have Quil Assure, the connected home platform sold direct to consumer, that helps seniors enjoy greater independence with exercising their preference for aging in place and strengthening that support between the family and friends serving as caregivers.

Seniors say they will accept some kinds of caregiver monitoring technology, such as fall detection and movement tracking, but draw the line at being monitored constantly by audio or video. How does that affect the ways in which monitoring can be performed?

In all of our research, we confirmed the same findings. We have 54 million unpaid caregivers in the country. There is a booming silver tsunami of seniors, and all of them want to live in their home as long as possible. When you start thinking about that dynamic, we need more technologies to help them live independently, but we need those technologies to be invisible to them. To support the caregiver, but also support the senior.

In our research, we focused on ambient sensing. We are leveraging some of the foundations that we know very well from the Comcast side of this joint venture, which is that connected home with motion sensors, door detectors, and connected hub. Being able to take machine learning and the bots that we’ve written to detect anomalies in daily patterns of living and notify on those anomalies. Then, also connect into the broader Internet of Things ecosystem that people have adopted across all ages.

With COVID, you are now seeing the 65-plus community being way more technology receptive. Being able to connect to their Apple Watch if they’re tech savvy. Being able to connect to their Alexa ecosystem for their weekly grocery orders. Having that open platform, but the importance being how the caregiver can verify that everything is OK. Did Mom get up on time? Are things going well? Has she been to the kitchen three times a day like normal? What going on that is abnormal? Did she leave the house for an extended period of time? All of those things to support the senior so that if they need help, it’s there.

How can technology address the key concerns of falls, wandering, and accidentally creating dangerous situations with normal household equipment such as stoves and bathtubs?

A lot of it is sleep quality, which is interesting. Are they getting around the house doing activities of daily living? Are they going to the kitchen? Are they not going to the kitchen? Are their bathroom patterns changing? In early trials, we’ve detected UTIs and other things because of just pattern anomalies. Temperature sensing is a huge one. We’ve had some seniors in the trial where they didn’t want to bother the caregiver, so when their heat went out, they just didn’t say anything. But then the system alerts when it’s turning to 55 in the room.

“Set it and forget it” ambient technologies don’t make them feel like they’re being watched. They’re not being actively probed. They don’t want to interact with the technology if they don’t have to. But then when it’s there, leveraging the pattern button, personal emergency response activation, or even if they’re connecting in the IoT ecosystem, “Hey Alexa, call Quil,” we can be there 24/7 to respond to those things. Sensors and triggers let us see certain patterns that would indicate a big abnormality, so we will start calling down the caregiver circle to make sure they’re checking in on Mom.

The old-school technology is to call the person daily to ask how they are doing and listen for anything concerning in their response or their voice. Do any technologies simulate that phone call type of monitoring?

We are doing insights in the app. The caregiver gets push notifications, text messages, and phone calls. They can see that Mom’s up and about and it looks like a great day. Those type of insights are coming back to the caregiver’s phone. The nice thing is if Mom is technically savvy, she also gets that same view. 

The interesting part is what we’ve learned from the caregivers. There’s this relationship that they are trying to form and it gets stressed when, every time you call, it’s about their health. There’s this fine balance between, “I know I’m aging and I know I have challenges, but don’t remind me of it all the time” and the caregivers saying, “I love being there for you, but it’s sometimes a little bit exhausting and I’m really worried that you’re not OK.” Bridging that relationship with insights that keep everybody on the same page — how things are going, any tasks and appointments coming up, medication reminders — and leveraging that technology to set those reminders so that Mom can acknowledge with their voice that they have taken that medication.

How does technology address those folks who are mobile and can run errands or visit a friend and the caregiver wants to make sure they get home when expected?

We detect when they leave the house, because then there’s no motion in the house and we have the door sensor. This is a learning system, so we learn their patterns over time. The caregiver can also set that they are on vacation or doing something abnormal. It isn’t sensing and triggering, but we are learning, “Looks like bridge club on Tuesdays, normal event. No worries, Mom comes back around 5:00 PM.” Those are the things that we are constantly fine tuning to make sure that we’re understanding the value that those insights provide. And respecting so that the senior in all of this knows what’s being shared, why it’s being shared, and how it’s helping with technology on their terms.

Big players like Best Buy and now Amazon, with Alexa Together, are involved in selling monitoring equipment and services directly to consumers. In Amazon’s case, it is powered by the same Echo devices that a competitor might use and is tied into third-party sensors such as fall detectors. How is the market evolving?

It’s the race to the connected home. I’m excited that we have a head start with Comcast. Then on the population basis, it’s that connectivity and receptivity of seniors to technology. As I mentioned earlier, I think that COVID has accelerated that comfort level with technology. I manage, or as I love to say, I love four people over 78 in my life. It’s hysterical that when I talk to them, if I’m not on FaceTime, there’s an issue – “Why aren’t you on FaceTime? I can’t see you.” Before the pandemic, that was never a thing. 

As we’re seeing this change in receptivity and now this race to the home, I’m also excited about the other side of our joint venture with Independence Blue Cross and the Medicare Advantage population. We see the joint venture through two very connected lenses. One being that we have “prescribed by provider” with Quil Engage. We have now the connected home. We are thinking about models of risk, pulling this all together to say, that’s what we mean by convergence with the home and health at home in a new way. 

It’s a really exciting time with lots of great players in this space. The question is, what level of depth in healthcare will each of the organizations go into? We’ve seen some early acquisitions that are indicators, but a lot more to come. I never dismiss Amazon ever, or Best Buy. Everyone is in this market.

Does the business model require running a 24/7 call center, or can companies provide just the technology without that escalation capability?

This goes back to what populations you’re serving for the level of escalation. We are looking at the market where safety protocols and emergency support are critical for a certain segment of the population. We think about this as a connected care circle, not just your daughter or your daughter’s husband, but even a neighbor just to check in. As we’re thinking about this, the setup and the onboarding process is critical to figure out and evolve with the senior and their patterns. Start with them. Call the house, “Hey mom, how’s it going? Everything OK?” I’m noticing some pattern detection. No answer, call the first person on the call tree, and then go down the list.

If we find something critical, we will absolutely send EMS, but we think about that person’s community and how they want to be escalated. We want to give them independence. With technology, we have so many different ways to turn on and off alerts and escalations based on their desire.

I worked at Philips years ago, and when we bought Lifeline, I got it for my grandmother. She was in an apartment building in Florida and had to do her laundry in the basement. She was taking a basket of towels down to the basement and she hit the button accidentally. EMS came and she was mortified, mortified. That button never went around her neck ever again – it sat in the basket by her bed. Unfortunately, she did have a fall in the house. Couldn’t get to the button. Thank goodness that she lives in the apartment building, because her neighbors checked in on her. It was her neighbor that found her three hours later.

We have learned so much about the sensitivity of the community, about what they want. Targeting their wishes. Do you want EMS to be initially protocoled or not?

The Echo devices have an option to connect with other devices in the neighborhood. Is there any movement to use that to create groups who can keep an eye on each other instead of going from zero to 60 in dispatching EMS?

We have that in the care circle pieces, where they can invite anybody they want, friends or family. They can designate who they are, what they can see, what they can’t see. You hit it spot on that there is a range between zero to 60, and the world of personalization matters to this generation. They want it on their terms. As we are fine tuning all of this, giving that control to the senior who could literally just turn off whoever they want, to turn off any time on their own device, because they’re seeing the same things that the care circle is seeing.

How do you contrast selling directly to consumers instead of to insurers or employers?

The fun part about this being a joint venture is that we get those great best practices from both parent organizations. Our direct to consumer approach was heavily influenced by best practices that Xfinity has done quite at scale with Comcast. Same with Independence. We’ve learned about routes to market for different populations and payers and self-insured employers and how they interact with companies. We’ve built models aligned with those best practices, and that’s allowing us the time to start this conversion piece and be different than some of the more traditionally funded companies. There’s always pros and cons for joint ventures, and this is one of the pros.

When you look at the entire market for remote patient monitoring and other work your company is involved with, how do you see the market evolving over the next few years?

The question that is so critical here is, what does convergence to the home actually look like? We keep on calling it the home like it’s a physical thing. I look at the home now in two different pieces, the digital home and the physical home, or homes plural in populations of different segments and demographics. 

As we start blurring these lines and we start seeing risk shift in different ways, this is where the models get really interesting. Whether it’s hospital  at home, in a risk-based sharing agreement with new signals from the home that are extended for this population as a benefit, wow, that’s an interesting model. If it’s, “I just had a health event, now the person that’s recovering is no longer steady and needs extra eyes,” there’s a referral model. Then there’s the direct to consumer model.

I dislike the word consumerism because really it does come down to, where is the risk, who’s the buyer, and what is the value being derived? How do you make sure you stay clear on that ROI to each of the parties? In a way, you start becoming this B2B to C2C connectivity arm that’s converging on the physical and digital home.

Morning Headlines 5/2/22

Walmart Health Introduces Telehealth Diabetes Program To Help Businesses Support Employees Through Education and Behavioral Care

Walmart rolls out a diabetes telehealth program for employers that includes diabetes education, behavioral health analysis and counseling, and discounts on insulin, diabetes medications, and test kits.

HST Pathways Announces Acquisition of Simplify ASC

Ambulatory surgery software vendor HST Pathways acquires competitor Simplify ASC.

Configo Health to relocate to Asheville, raises $2M for growth in Western NC

Configo Health, a North Carolina-based startup that has developed benchmarking analytics for pediatric hospitals, raises $2 million.

Monday Morning Update 5/2/22

Top News

Walmart rolls out a diabetes telehealth program for employers that includes diabetes education, behavioral health analysis and counseling, and discounts on insulin, diabetes medications, and test kits.

The program was developed with the American Diabetes Association.

The service is provided through MeMD, a Phoenix-based multi-specialty telehealth provider that Walmart acquired in May 2021.

Walmart will sell the program as a standalone offering or as part of a comprehensive telehealth program.

Reader Comments

From Enumerator of Beans: “Re: Teladoc’s share price. Stupendously bad, but take a look at Amwell’s enterprise value, which is less-famously awful.” Refresher: enterprise value (EV) looks beyond a publicly traded market capitalization to also include the company’s debt and cash, which is how a potential acquirer would evaluate it. Amwell’s market capitalization is around $900 million as Teladoc’s woes dragged AMWL shares to record lows, but even worse, Amwell’s EV has tanked from $3 billion a year ago to $150 million now, which seemingly provides a buying opportunity for the strong-stomached investor or down-trending competitor. Teladoc’s market cap has shed more than 80% in that same year as EV slid from $29 billion to $6 billion even as management was hyping the company’s business prospects (I can’t imagine that won’t trigger a bunch of lawsuits). The smartest person in the telehealth room turns out to have been invited visitor Glen Tullman, who found a buyer-in-heat in Teladoc who was willing to massively overpay for largely untested Livongo in that brief pandemic moment where telehealth looked unstoppable, insatiable investors were wildly overfunding digital health companies, and companies sought acquisitions that would arouse or confuse investors (or both). No wonder Glenn is ubiquitous as a conference keynoter, with the sometimes comical train wreck that was Allscripts under his watch being long forgotten.

From Curious from Across the Pond: “Re: American healthcare. Has all the money spent my vendors and the federal government actually improved patient care compared to Europe? It seems that most of the money is to make sure that health systems can bill and collect for ‘patient care’ and that it’s all about growing market share and preserving monopolies and patient care is the last thing on their mind.” US healthcare is bureaucracy-powered big business, not a social obligation, but governments love it because it creates high employment, big political donors, the illusion of economic growth, and shiny new buildings where politicians can pose cutting ribbons. Technology and policies that claim to have the power to improve outcomes and cost can only be as effective as the underlying healthcare system they support, and ours is a mess with no political will to change it given that the wealthy like it just fine. As far as health IT claims, vendors and fawning press cheer every announcement but fail to mention the frequent failure that follows or the user missteps that contributed.

HIStalk Announcements and Requests

Poll respondents say that the factors that are most important to AI’s eventual success in healthcare are maturation of the technology, proven outcomes, and building trust. Commenters noted the need for better-quality EHR data and the alignment of economic incentives.

New poll to your right or here: Within the past two years, have you had to pay a medically related bill that created at least a modest degree of financial hardship?

I received a brilliant spam email this week – Bitdefender warned me that the “unsubscribe” link pointed to a phishing page.

Webinars

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

Acquisitions, Funding, Business, and Stock

Weight loss app vendor Noom lays off 180 coaches and will part ways with 315 more employees in the next few days, according to a Business Insider report. The company is trying to pivot to scheduled video-based coaching instead of immediate text-based engagement that often involved canned messages and lessons. At least the company is loyal to the video-based model – the employees who were laid off were notified in group video calls.

Spok announces Q1 results: revenue down 6%, EPS –$0.37 versus –$0.12. The company says its strategic alternatives review resulted in no options to sell the company, so it will continue to operate as a standalone business.

Ambulatory surgery software vendor HST Pathways acquires competitor Simplify ASC.

People

Renee Emmer, RN, MS joins VCU Health as associate VP of clinical informatics.

Ann Baty (OmniSys) joins HealthMark Group as VP of marketing.

Announcements and Implementations

Olive releases Care Campaigns, an automated patient communication and outreach solution whose first user is Gundersen Health System.

Canada’s seven-hospital Hamilton Health Sciences will go live on Epic on June 4 in a rare move straight from paper charts that are scanned into CGI Sovera.

Aurora St. Luke’s Medical Center (WI) joins a clinical trial of UltraSight Echocardiographic Guidance, a machine learning app that helps medical professionals who don’t have advanced echocardiography training to position the transducer.

Rochelle Community Hospital (IL) goes live on Epic, replacing Meditech and Athenahealth. 

Oxford University Press launches Oxford Open Digital Health, an open access journal that will focus on digital health interventions in low- and middle-income countries. The editor-in-chief is Alain Labrique, PhD, MHS, MS, professor and founder of the Johns Hopkins University Global MHealth Initiative and chair of the WHO Digital Health Guidelines Development Group. 

In Norway, St. Olav’s Hospital trains volunteers from the local senior center on HelsaMi, its patient portal that is powered by Epic MyChart, so they can help other seniors.

Government and Politics

Interesting from Politico: a historical graph of how many years Medicare’s Part A fund for hospital expenses has left before running out of money. Today’s number is four years, as in 2026 the fund will go broke because the number of enrollees and their expenses has risen faster than funding from payroll taxes, and that doesn’t even account for pandemic-related impact. The long-term fix would be to shift to value-based care, which would require not only a lot of legwork, but rare political unity. The “gimmick fix” would be to shift some Part A services to Part B, which is funded by premiums and other taxes.

Other

Neonatologist Ross Sommers, MD, who recently founded NICU-at-home monitoring software company Firstday Healthcare, posted this on LinkedIn. I found it interesting given the cost and family disruption involved with NICU babies. The company offers continuous vital signs monitoring monitored by board-certified neonatologists, AI-powered deterioration prediction, a parent app that includes medical records, and care coordination.

A small University of Colorado survey of patients who were given online access to their radiology images and reports finds that most said it was helpful in understanding their condition and few reported being worried or confused. One-third of them saved a copy, one-fourth shared them with a doctor, 15% used them to get a second opinion, and 3% posted them on social media.

Sam Johnson, fired last year as CEO of telehealth vendor VisuWell after he was caught on video telling high school senior Dalton Stevens that they “look like an idiot” for wearing a dress on their way to the prom, sues comedian Kathy Griffin for making fun of him. He says the ridicule triggered a backlash against him and his family. Johnson says he is suing “to stand up against the woke social mob that wants to strip of us of our livelihoods and careers.” He says his issue wasn’t the student’s attire, but rather that the group was being obnoxious and profane in one of his favorite restaurants. Johnson says that he will never again sign an employment agreement that doesn’t contain a “slow action cause” that subjects employment actions resulting from a news story, social media post, or boycott demand to a 30-day cooling-off period. Johnson says that VisuWell and “several health systems” made false statements that were published and urges followers to read the coverage on Fox News. Two months ago, he accused the Nashville Business Journal, VisuWell, and LinkedIn of flagging one of his LinkedIn posts as harmful, which he summarizes as “scared pansies.”

The metaverse quickly got creepy. Bored Carnegie Mellon researchers fit haptic sensors into an Oculus Quest 2 headset that transmits kissing sensations to the wearer’s lips, teeth, and tongue. They describe mundane game-playing uses such as brushing teeth, smoking, and drinking coffee, either naively or coyly overlooking more lucrative integration. SecondLife perverts have a new home.

Sponsor Updates

• KLAS research ranks Meditech among the top two EHR vendors market share growth.
• EClinicalWorks releases a new podcast, “How EClinicalWorks RCM Service Boosts Efficiency.”
• OptimizeRx will exhibit at MedDev 2022 June 7-9 in San Diego.
• Optum donates COVID-10 test kits to increase access to free testing among underserved communities in Chicago.
• PatientBond will exhibit at the UCA/CUCM 2022 Annual Convention through May 4 in Las Vegas.
• PerfectServe will present at the Powderkeg Unvalley virtual conference May 11-12.
• Premier’s S2S Global donates urgently needed medical supplies to Ukraine via United Help Ukraine.
• The HIT Like a Girl Podcast features Tegria Director of Patient Access and Technology Rodina Bizri-Baryak.

Blog Posts

• Stop Making Patients Work So Hard (Orbita)
• Preventing Violence Against Healthcare Workers: Perspective From a Former CEO (Commure)
• How the Pandemic Changed Patient Experience, and Why It Matters (Symplr)
• X12 got you down? Light it on FHIR with Redox. (Redox)
• 10 interesting facts about nurses (Spok)
• Innovation Allows for Swifter, Smarter Specialty Prescribing & Fulfillment (Surescripts)
• How payers can improve member experience with modern contact centers (Talkdesk)
• Improving Healthcare Communication and Collaboration within Doctors’ Offices and Beyond (TigerConnect)
• Top Things to Know About Patient Engagement Technology (Twistle)
• Filler Words to Avoid in PT Treatment Notes (and Other Documentation Missteps) (WebPT)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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