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Readers Write: Inside the Most Challenging Data Problem in Healthcare

July 28, 2021 Readers Write 2 Comments

Inside the Most Challenging Data Problem in Healthcare
By Navdeep Alam

Navdeep Alam, MS is CTO of Abacus Insights of Boston, MA.

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Payer data is one of the most exciting assets in healthcare, holding the most promise for dynamic, meaningful change to the way care is delivered and paid for. It’s also the most challenging data problem to exist in the industry. 

We may not always realize it, but payer data is often the center of discussion around dinner tables across the country. Whether we’re talking about which treatments are covered by our health plan, how much our prescriptions cost, or how our specialists and primary care physicians interact — or fail to interact — we’re actually talking about payer data. When we have questions about our care, the first call we make is to our health plan, and we hope they have the wisdom and expertise to point us in the right direction. 

Payers are the hub of healthcare. Our health plan is where we as consumers begin when we’re trying to navigate the healthcare landscape. Where do we go to receive care? What treatments are best for us as individuals? Which pharmacies can fill our prescriptions?

As we interact with the healthcare system over our lifetimes, our experiences are eventually filed as insurance claims. Health plans hold treasure troves of rich, complex data about the patient journey, information that is critical to understanding how we as individuals experience healthcare. 

This is why healthcare can be so complicated: We have barely scratched the surface in realizing the potential of payer data. 

Healthcare data does not come from a single source. It comes from electronic health records, primarily used for documenting clinical data. It comes from pharmacy records, which were designed primarily for inventory management. And it comes from insurance claims, which lack detail about the patient journey but are necessary for tracking our experiences across the healthcare system. All of this data is growing at an exponential rate. Over 1.2 billion clinical documents are produced annually in the United States, and that figure is growing at a rate of 48% per year — and it’s all held by health plans. 

Health plans are ingesting millions of data points every day, and all of it is necessary to ensure that we, as patients, are receiving the right care at the right cost. If this data were clean and structured in the same format, it could paint a beautifully elaborate picture of how we experience healthcare every day. But it is not: 80% of medical data, for example, is unstructured and therefore disconnected from the wider healthcare system. 

Ultimately, all data challenges across the healthcare system become payer data challenges. Our health plans are burdened with the responsibility of mediating these challenges and piecing together all of the fragments of our healthcare experiences. When we switch plans, those challenges are exacerbated: all of our information is siloed within our old plans, and our new plans are barred from seeing a full picture of our medical histories. This disjointedness within the system, coupled with prohibitive privacy regulations, is how we end up with multiple sources of “truth” for every patient. The result is wide variations in the quality and cost of care we ultimately receive. 

The healthcare industry has been attempting to confront these issues for decades, despite spending nearly $2.1 billion annually to try to resolve them. These challenges can be boiled down to three major roadblocks. 

  • Data capture. There is a longstanding inability among health plans to capture clean, and complete data in a timely manner. This is largely due to legacy systems and the continuation of highly manual data processes as best practice, all of which lead to a bevy of downstream issues. 
  • Data cleanliness. Payers receive and ingest millions of messy, mis-formatted data points from different providers, data suppliers, and vendors every day. The lack of standardization of these data creates inaccuracies and inconsistencies. Fragmented data often remains siloed within health plans, non-interoperable and underused.
  • Data sharing. The lack of standardization of data within health plans makes data sharing impossible. CMS’s interoperability mandate is a much-needed first step toward addressing this issue and will certainly be a driver toward more efficient data sharing practices, but it is exactly that, a first step.

Overcoming these challenges is not impossible, but it requires the best tools and immediate action. According to a recent PwC survey, only 53% of payers have mapped out their data to see what will be impacted by the CMS interoperability mandate. Even more concerning: only 24% of healthcare executives said they see the mandate as a strategic opportunity. Here’s how payers can act now to unlock and realize the full potential of their data.

  • Clean up data. Now more than ever, patients have greater control over their data — data which, at the moment, is largely fragmented and incomplete. Payers should strive to achieve a single source of truth for each member. Doing so will allow plans to develop personalized member benefits and give providers a complete view of each patient, allowing them to make more informed clinical decisions and empowering patients to stay healthier, longer.
  • Advocate for and improve interoperability. The CMS mandate is a necessary first step, but simply following the mandate is a missed opportunity to innovate and create real change in the ways in which we experience healthcare. It is imperative that payers take up the mantle and champion interoperability from this point forward. We cannot wait for the next iteration of interoperability regulations to improve the quality of healthcare data. Payers should be contemplating ways to ingest quality data, generate new insights, and work with one another to meaningfully engage patients as we experience healthcare.
  • Democratize the use of payer data. Payers cannot drive innovation themselves. The promise of interoperability will only be realized once payer data is shared widely, allowing others to drive innovation, improve connectivity, and enhance our interactions with the healthcare system. By giving patients control over their healthcare data, we’re opening a new realm of possibilities. It is upon payers to lead the charge as we step into the future of healthcare.

With the CMS interoperability mandate, health plans have the chance to change the narrative: what has historically been an industry data challenge is now a business opportunity. By taking  action to unlock healthcare data today, health plans can drive efficiency within the industry and innovate to build a more seamless, engaging, and dynamic healthcare system.

HIStalk Interviews Justin Dearborn, CEO, PatientBond

July 28, 2021 Interviews No Comments

Justin Dearborn is CEO of PatientBond of Salt Lake City, UT.

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Tell me about yourself and the company.

I started with PatientBond as CEO in January of this year. Prior to PatientBond, I was CEO of Merge Healthcare from June 2008 through October 2015, when Merge Healthcare was acquired by IBM and formed the basis for Watson Health for a while until their next big acquisition. I took a pause after that in healthcare, went and did a few other things in different industries, and then found my way back to healthcare.

I took your 12-question Patient Classifier psychographic segmentation survey. What are health systems learning about using consumer insights in their outreach and messaging?

I saw you took the classifier, so thank you. You and I are both priority jugglers at a high rate. You fall into multiple categories, and then we segment you based on the highest category, and you are very high and I’m very high on the priority juggler spectrum of the model.

What a health plan, payer, physician group, or specialty pharmacy is trying to activate in their client, member, or patient determines how they start using the psychographics and segmentation platform. Ultimately it is to trigger and activate positive behavior, such as keeping an appointment, filling out a survey, or all the way to collections or the financial side. It is triggering that process.

What all of our clients and most health systems are starting to realize is that they need to treat their patients similar to a consumer. One size does not fit all. Some segments of the population react well to physician-based messaging, where your doctor wants you to do X, Y, and Z. That segment of the population will do that without any other prompting or any other pushing needed. But a large portion of the population that doesn’t react the same. 

A lot of healthcare is messaging is towards the one segment. We dynamically personalize it based on what segment we’re speaking to. The customer doesn’t need to understand the concepts, but they are seeing the results in better engagement with the patient, more engagement, and getting across the spectrum of things from marketing outreach to medication adherence to really involved specialty pharmacy workflows.

It really depends on the workflow you are trying to achieve. But the bottom line is better engagement with your patient or member because you are speaking to them in a modality they want to use, in language they want to hear, and in words that they need to see to be activated.

Do providers ask their patients questions specifically to create a more accurate psychographic profile, or do they infer it from existing information?

Our system learns. We think you want to be communicated this way, in this frequency, and using these words. If it’s an ongoing communication path, our system will learn. We thought you would like text messaging and you need to see one message a day to activate this behavior, but it turns out now that one message a week in an email is better. We can learn from that and personalize the communication path based on that.

Health systems have done a great job, and are getting better all the time, at using AI to harvest their claims data. If it’s an existing patient, they have that data. They might have some socioeconomic data or social determinants of health data. If the health system has those components, we say, great, let us append the psychographic segmentation model to that – it will be even smarter, better outreach because you’re going to have historical data, which is informative for sure.

But what psychographics really gets to is the why and the how. It doesn’t focus on the historical. The historical can be informative, and there are certain things you can tell from a ZIP code or a salary that might impact payment ability, but really what the psychographics does is get behind the why and the how. This came out of Procter & Gamble and a number of high-quality, consumer-facing companies have used this for decades to segment consumers on a mass scale, as well as individual, and we can do both as well.

The classifier allows us to segment you with 91% accuracy. If we didn’t have that relationship, or if you were doing a marketing outreach to attract patients that you don’t know, we would take a national compiler’s database and append our model to it. That would be three times more accurate than chance on segmenting you properly, but it’s still not the number we get if you do the 12 questions.

Many people heard of psychographics in relation to Cambridge Analytica or Facebook collating a lot of data without user knowledge or permission to study their behaviors. Did these examples teach us that psychographics does or doesn’t work, especially in healthcare where the results would be used to improve the individual’s outcomes instead of trying to influence them for less-noble purposes?

I’ll start with the last piece of that. We believe in the health systems that we are working with. We believe in the payers. It’s really about activating positive behavior — making sure you take your medication, making sure you do your annual physical, or prompting you the best we can to get your colonoscopy. I think we would all agree that these are healthy behaviors. We’re not showing the data. In that case of Cambridge and Facebook, if the hospital did license the Facebook data — which we did at Tribune Company, for instance — that would still be separate data. That would go more to the social determinants of health datasets, and we could still use that and append psychographics to that.

To the first part of the question, part of our challenge with PatientBond has been awareness. Since I came in with the Series C investment round, we have been doing more on the outreach, more brand-building. We have started engaging with KLAS and Advisory Board and things like that. Frankly, the company didn’t have the budget to do it in the past. Half of our engagements are evangelizing, so a couple of calls will involve explaining the psychographics model, the history and genesis of that, how we get the data, what the clinical efficacy is, etc. 

Usually light bulbs start popping on. The client, the health system or payer, will start coming up with use cases. Could you do this? How do we operationalize it here? It’s a little bit of, I’ll say, free consulting and evangelizing. But once we get into a pilot mode, it pretty much takes care of itself. Then someone from the marketing or strategy group typically owns the project.

Absolutely awareness is still a challenge, but we’re working on that daily. There was a great paper put out by McKinsey about a month and a half ago that mentioned psychographics a number of times and the way they engage patients more effectively. That was unprompted by us. They found us and did the research and didn’t call us on it. Same with the Advisory Board. They put out a good case study with TriHealth and we were not contacted, but we were named. They both had some great results. So it really is about awareness.

Last year, of course, it was difficult to get mind share with the obvious situation at hand with the pandemic. This year is around awareness of PatientBond and the mission. It’s hard to say in healthcare IT. I was at Merge Healthcare and we had great products, but it’s hard to differentiate yourself. Most of the segments in healthcare are pretty crowded with vendors, but I can say there is no other company doing psychographic segmentation modeling and has our platform. 

There’s a lot of M&A on the AI side that do claims data analysis. Systems will recommend what they think would be the outcome based on historical, which is good stuff as well, but really nobody uses psychographics. A lot of the situations we are in are not competitive, but involve evangelizing and explaining in the first couple of calls.

Are health systems reluctant to apply marketing techniques to patient relationships that are more intimate than just consumer awareness campaigns? Or have their marketing folks not been involved and that will change with the new emphasis on consumerism as overseen by C-level executives?

I truly believe it’s the latter. It’s just coming of age. I’ve spent 10 years in healthcare and I can remember growing up that you didn’t see marketing from health systems, your doctor, or your hospital. I grew up around Northwestern Hospital and they didn’t advertise, but they do now. They have marketing budgets. They have data scientists.

That has evolved for the better. How to engage. How do people want to be communicated with, like text messaging versus email or IVR? Or, do you need to talk to a human being? We are informing them on how to best communicate.

That has been going on in CPG, consumer packaged goods, for 30 years. CPG used it effectively. Proctor & Gamble are masters at consumer marketing, but they don’t necessarily have the one-to-one relationships that can be built at health systems. You’re not as intimate when you’re buying Tide detergent, so when they are applying psychographics to something like Tide, it is more of a carpet bombing. They’ll profile an area and say, this area is over-indexed for priority jugglers, and here’s the messaging, here’s the labeling, and here’s what we need to do to resonate here.

But with health systems, it is truly one to one. Once they are a member or patient client, it’s one to one, and we truly personalize it for each one. That’s a huge, huge upside and more productive.

I truly believe it is awareness. In none of the calls that I’ve been on in the past six months — and there have been a lot —  did the chief marketing or chief strategy officers not get it, not believe in it, or decide that “we’re good with what we’re doing.” It’s more of, this is really intriguing,. How would we operationalize this? How does this work with our CRM? How does it work with our EMR? There’s has been a lot of great commentary, feedback, and follow-on loops.

I would say it’s coming fast. We probably would have seen a bigger uptake last year but for the pandemic, but as hospitals get back to normal a little bit, it is all about treating the patient as if they have choices, which they do. Probably this year or maybe next year, people will be paying 50% out of pocket for their total healthcare costs. We’ve been talking about it for 10-15 years, but the patients will be in charge. They are starting to make decisions somewhat based on price, how they like doing business, and how they like the relationship. That has been evolving for a while, but it’s going to cross the 50% threshold here very soon, and patients will act like consumers. It’s coming and it’s going to come fast.

We’re seeing that increasing COVID-19 vaccine uptake isn’t a simple as informing people who are uninformed, so now we are trying to understand their beliefs and nudge them accordingly. Has that raised awareness that targeting patients who meet some criteria and hitting them with cookie-cutter messages probably won’t work?

That’s a great analogy. We surveyed 4,000 people with 400 questions around motivation for vaccination. We came out of that with a ton of data. It is coming to light right now that you can’t treat everybody the same. It’s not all about just being an anti-vaxxer. There are other motivations and other things you can point out, and it’s information. Some people need more information. Some need to have their clergy talk to them about it. It’s all starting to come out as we hit the wall. We predicted four months ago that we would hit the wall in June at about 65%. We were spot on. We had this great data built into the platform as how to basically get people who are close over the hump and off the fence.

We have been trying to get that data out there. The challenge is who ultimately is motivated and incentivized to get people who aren’t vaccinated to get vaccinated. Now it has become more of a public service. For health systems, it’s for the common good, but do they even have a relationship with people who aren’t vaccinated their community? Not always. Early on, employers were being hands off because it was a hot potato. It was hard for us, and it still is hard for us, to find a group that has the incentives to get behind this.

We are willing to share the data and share our insights on how we feel that you can move the needle on that. But that has been a challenge because there has been no ownership. The federal government is supportive of it, but other than making it free, there’s really not much else. To your comment, we are absolutely, definitely informed that you can’t treat everyone the same. You can’t have one billboard. That’s not going to resonate with all the groups.

What will the company’s strategy be over the next few years?

It’s about marketing awareness. We’ve tripled the go-to-market team, the sales team, in the first six months of the year. We’ll grow 100% this year, and I think we’ll continue that path. The really attractive piece for me coming in was that we have a somewhat “friends and family” board of directors. There’s really only one entity of professional money, which is First Trust, who has a legacy investment and is a great partner. The rest are family office and individual. It allows me to manage the company for growth and to see this thing through.

We have a huge runway ahead of us. I don’t have any investor pressure. There’s no timeline. We have enough of a platform, and it keeps growing weekly, that we can remain private and self-funded for eternity. Eventually we’ll come to a decision point in a couple of years about an IPO or something else, which is the natural evolution of an early-stage growth company, but the good piece for me was not having external pressure from traditional venture capital investors.

An HIT Moment With … Steve Shihadeh

July 28, 2021 Interviews 3 Comments

An HIT Moment With … is a quick interview with someone we find interesting. Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

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What advice are you giving clients about participating in HIMSS21 and HIMSS22?

I am very hopeful that HIMSS22 will return to a more normal trade show to meet the pent-up demand on both the vendor and provider side. 

With all of the COVID churn, mask debates, and travel challenges, we are advising clients who want to go to HIMSS21 to be surgical about their investment. By this, I mean that they should have a narrow list of who they want to visit and what they want to accomplish and generally be in and out in a day or so to keep expenses to a minimum. 

I get the sense that vendors are being cautious about investing, and a quick look at signups bear that out. If vendor attendance is light, I would have to guess that provider participation will be down significantly as well.

How are companies changing their marketing strategy?

With in-person trade shows effectively non-existent since March 2020 — by the way, every client we have talked to has felt that the virtual shows were a bust — companies have adapted marketing significantly to keep their businesses vital.

A few clients have upped their webinar game with real thought leadership and way more nuanced selling than in the past.

I continue to be impressed by how much mileage our clients are getting out of social. They are making use of multiple channels and keeping it edgy and interesting. The really sophisticated companies are getting participation across their employee base, which is greatly amplifying their messaging.

We have participated with our clients in a number of focus groups, and while you don’t get the reach of large-scale events, you certainly get to go way deeper. It seems like picking the right attendees and having a solid structure to the events reaps the most reward.,

How has the sales process changed post-pandemic?

Value prop, value prop, value prop. With in-person meetings dramatically reduced in both number and time allowed on site, companies need to more than ever translate their bells and whistles into things that matter to the client. How exactly does it save money? How exactly does it positively impact clinical workflow and outcomes? How exactly does my taking a meeting with you help my organization dig out of this COVID hole?

What are the most important things you look at when asked to perform due diligence for a potential health IT investment or acquisition?

Value prop, value prop, value prop. Just kidding, but not really. Investors get this more than anyone and want to deeply understand a company’s storyline and associated ROI. Investors at different stages – seed, venture, growth equity, private equity, strategic — will have different expectations, but they all need to understand how you truly differentiate and how you truly help a provider with a key challenge.

What clues will the HIMSS21 exhibit hall provide about the direction of the health IT market and the companies in it?

The health tech market is coming back red hot, in my opinion. The pandemic has broken the status quo and providers are finding new ways to use technology and new problems it can solve. Hopefully HIMSS21, albeit with a lighter attendance than in the past, gives us a glimpse at how companies have responded to the many opportunities presented by the COVID crisis.

Morning Headlines 7/28/21

July 27, 2021 Headlines No Comments

Nordic Capital in Talks to Buy Health Tech Firm Inovalon

Bloomberg reports that Europe-based private equity investor Nordic Capital is in talks to acquire health data analytics vendor Inovalon.

New tool for early identification of COVID-19 surges

Kaiser Permanente develops a COVID-19 HotSpotting Score to help providers predict COVID-19 surges up to six weeks ahead of time.

Teladoc stock drops after telemedicine company reports wider quarterly loss

Teladoc shares drop 7% in after-hours trading after the company reported a greater-than-expected Q2 loss of $133.8 million.

News 7/28/21

July 27, 2021 News 2 Comments

Top News

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British health IT company System C acquires medication management vendor WellSky International from parent company WellSky Corp.

WellSky International will change its name to CareFlow Medicines Management and operate as a division of System C, which primarily serves NHS trusts.

WellSky International, the former JAC and Mediware Information Systems BV, took that name in mid-2019 following the 2018 renaming of then-parent company Mediware to WellSky.


Reader Comments

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From Essential Oils: “Re: McLeod Health, SC. Replacing Cerner with Epic.” Verified, according to a health system announcement. The health system chose Cerner Millennium in late 2016 to replace Cerner / SMS Invision and Soarian. The first of McLeod’s seven hospitals went live on Millennium in early 2019 and the rollouts continued through at least early 2020, so that was a short stay. The health system says that the move to Millennium was the largest project in the health system’s history.

From Nanner Puddin: “Re: HIMSS21. My company has zero confirmed face-to-face meetings versus our requirement of having five booked at least two weeks before the conference, so we have decided against attending.”

From New to the Startup World: “Re: EHR. I recently started working at one of those telehealth disruptor type Silicon Valley startups after many years in health IT. I laughed so hard I nearly fell out of my chair when I heard they are planning to build their own EHR. I don’t see how they can get by without a certified EHR and I don’t see how it makes sense to build one purely for internal use. Amy I the crazy one? Does anyone still build their own EHR? Can you get by without a certified EHR? Oh, also note that the company does not have any staff with EHR experience.” I used to argue that non-traditional providers that don’t deal with insurance could gain competitive advantage by building their own EHR-lite that is centered around patients and providers, basically more like a CRM (although for that purpose, maybe an actual CRM would be the best option). A few investor-backed primary care companies that tried that failed, although most likely for other reasons. The Silicon Valley argument for building would be Uber or other company whose entire physical and business presence is a seemingly simple app that is powered by a lot of hidden computing power. A smart, aggressive, well-funded, and disruptive telehealth provider might convince me that a custom-developed EHR is essential, but hopefully they at least keep integration in mind since we’ve learned that even telehealth companies with their own providers can’t exist responsibly in a medical silo.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

On-Demand Webinars:

Key Differences: Value Based Care vs. Fee-For-Service.” Part 1 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 1 webinar covers which aspects of the fee-for-service health system payment model look the most different compared to fully value-based systems (clinical, back-office, analytics, etc.)

Current Innovation and Development in Value-Based Care.” Part 2 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 2 webinar discusses what health systems should know about the transition to value-based care, including macro versus micro shifts.

Future of Value-Based Care: Predictive Analytics, Technology, Policy.” Part 3 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 3 webinar discusses the role analytics will play in the shift to value-based care and how financial and clinical ROIs for analytics-oriented products must differ when applied to FFS and VBC models.

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


Acquisitions, Funding, Business, and Stock

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Bloomberg reports that Europe-based private equity investor Nordic Capital is in talks to acquire health data analytics vendor Inovalon. Since going public in 2015, Inovalon has acquired Avalere Health, Ability Network, Complex Care Solutions, and Creehan & Company. INOV shares rose 70% in the past 12 months, valuing the company at $6 billion.


Sales

  • CPSI will integrate Medicomp’s Quippe Clinical Data Engine with its acute and post-acute EHR products.
  • Adventist Health (CA) selects GetWellNetwork’s full line of digital patient engagement technologies.
  • In Australia, South West Alliance of Rural Health and Barwon Health will deploy the InterSystems Iris for Health data extraction and analysis software.
  • LTC ACO will implement PatientPing’s real-time care notification and coordination software across more than 700 member facilities.
  • Marshfield Clinic Research Institute (WI) joins TriNetX’s global health research network.
  • The ACT Health Directorate in Australia will use Capsule’s device integration technology to connect medical devices with its new Epic system, set to go live in September.
  • Everest Rehabilitation Hospitals will implement WellSky’s rehabilitation software, including its EHR, across its facilities in Texas, Arkansas, Ohio, and Florida.
  • LifeBridge Health (MD) selects Intelerad’s cloud-based medical imaging managed services.
  • University Hospitals (OH) will launch its Hospital at Home program using Edgility technology.
  • HealthLinc will use Greenway Health’s telehealth solution.

People

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Siv Raman, MD (Lumilla) joins 314e as chief product officer.


Announcements and Implementations

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Infor announces GA of its FHIR Server for improved data storage and exchange based on the FHIR standard.

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Ochsner Health (LA) adds ActX’s genomic decision support to its Epic system.

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UnityPoint Health develops social services referral software using technology from Aunt Bertha.

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I assume all of us HIMSS members received an email today pitching Accelerate, a HIMSS-developed app that hopes to connect users, HIMSS-designated thought leaders, and HIMSS exhibitors and content. Mostly so far it seems to push Healthcare IT News articles into a news feed. HIMSS apparently formed a new company called One OpCo, LLC to support the app and apparently hopes to sell it to “enterprises, organizations, and associations interested in getting access to their members.” HIMSS uses Accelerate name for innovation-related products, including what used to be called VentureConnect. The app tracks a ton of user data, according to app store privacy details. I don’t see me launching the app a second time since I rarely find HIMSS-generated content useful and my experience is that healthcare IT folks aren’t interested in contributing content and participating in discussions.


Other

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From Tuesday afternoon’s CDC press conference:

  • Fully vaccinated people are now advised to wear masks when indoors in areas where spread is extensive.
  • Teachers and students are urged to wear masks indoors regardless of vaccination status.
  • The Delta variant makes up 83% of new cases and most transmission is occurring in low-vaccination areas, which includes most counties in Arkansas, Louisiana, Missouri, Mississippi, Alabama, and Florida.
  • It appears that some people who have been vaccinated can spread the Delta variant, which wasn’t common with previous strains.
  • CDC Director Rochelle Walensky, MD, MPH said that coronavirus is “just a few mutations potentially away” from becoming resistant to COVID-19 vaccines.

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Penn Medicine (PA) will launch the Center for Applied Health Informatics to develop best practices for data projects across its health system and foster informatics leadership. Initial projects will focus on telehealth expansion and COVID-19 response efforts. Collaborators will include Information Services, the Center for Health Care Innovation, and the EHR Transformation team, among others.

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Kaiser Permanente develops a COVID-19 HotSpotting Score to help providers predict COVID-19 surges up to six weeks ahead of time. The predictive modeling tool’s estimates, which incorporate variables like COVID-19 test rates, inpatient and clinic data, and call center and patient email data, strongly correlated with COVID-19 hospital activity during the last half of 2020.


Sponsor Updates

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  • Cerner receives an award from the Missouri House of Representatives commending its mass vaccination efforts during Operation Safe.
  • CloudWave and Vital Images will partner to deliver enterprise imaging as a cloud-based service.
  • Audacious Inquiry and the Georgia Hospital Association announce that hospital participation in GA Notify, powered by Audacious Inquiry’s Exposure Notification Service, has tripled over the past six months.
  • Optimum Healthcare IT publishes a video titled “Optimum CareerPath: A Different Approach to Building a Team.”
  • Mach7 Technologies has received the Frost & Sullivan Global Enterprise Imaging Solutions Product Leadership Award, has been recognized by Industry Tech Insights magazine as one of its Top 10 Companies Revolutionizing Healthcare in 2021, and has been named one of the Top 20 Most Promising Workflow Solution Providers by CIO Review magazine.

Blog Posts


Contacts

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

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Morning Headlines 7/27/21

July 26, 2021 Headlines No Comments

Penn Medicine Launching Center for Applied Health Informatics

Penn Medicine (PA) will launch the Center for Applied Health Informatics to develop best practices for data projects across its health system and foster informatics leadership.

Epic’s AI algorithms, shielded from scrutiny by a corporate firewall, are delivering inaccurate information on seriously ill patients

STAT sheds light on an Epic program that incentivizes customers to use its algorithms, one of which – sepsis prediction – has been found to not work as well as advertised.

Komodo Health Acquires Breakaway Partners to Improve Patient Access to Effective Therapies

De-identified patient data and analytics company Komodo Health acquires Breakaway Partners, which offers market access analytics.

Curbside Consult with Dr. Jayne 7/26/21

July 26, 2021 Dr. Jayne 2 Comments

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I learned a valuable lesson in procrastination today, as I delayed writing until after I had an unfortunate encounter with a cheese knife. It was a classic blunder because I was in a hurry, and now I get to figure out how to type with fewer digits because I forgot how much finger lacerations hurt. It’s a good thing I’m not seeing patients in person right now because proper hand hygiene would certainly be a challenge. Public service announcement: don’t cut toward yourself, folks.

I should be practicing music in preparation for a recording that’s due soon, but that’s not going to happen. In the meantime, I’m recuperating by catching up on my journal articles and some light Netflix watching, which I almost never get to do. One of the first articles to catch my eye is timely given the state of burnout among my healthcare colleagues. It deals with the evaluation of resident physicians as to their level of “grit” and its association with wellness outcomes. The personality trait of grit is defined as “perseverance and passion for long-term goals.” Grit has been associated with conscientious behavior and higher levels of hope. In healthcare, those with higher grit scores have been associated with lower burnout scores.

The article looks specifically at the association of grit scores in surgical residents with burnout, thoughts of leaving the program, and thoughts of suicide. Researchers tested residents following the 2018 American Board of Surgery In-Training Examination. Where previous studies looked at data for residents in a single institution, this approach allowed them to look at nearly all clinically active surgical residents. Although the scores varied between programs, they found that residents with higher grit scores were less likely to have burnout, thoughts of quitting, or thoughts of suicide. It also confirmed that residents overall continue to have unacceptable levels of burnout, suicidal thoughts, and thoughts about leaving their training programs.

Fast-forward a couple of years and we have a situation where physicians and other healthcare providers around the world have been pushed to the brink. Many of them are working hours that are similar to what they worked in residency or their training programs, except now they’re responsible for these larger patient loads and sicker patients rather than being in training. It’s a heavy burden to bear and this week I saw four more of my colleagues resign from medicine. Mentally it seems worse, I think, because the patients are often in the situations that they are in by choice – by refusal to vaccinate, wear a mask, or practice social distancing. It’s hard to manage the cognitive dissonance around putting yourself at risk caring for others who didn’t take basic precautions.

As a clinical informaticist, I’ve learned to tread lightly around physicians and other care team members who are stressed. It’s important to know what else has been going on in their days before figuring out the best approach to training them or working with them in meetings. For example, did the OB/GYN on the committee just come out of a disastrous delivery, and that’s why they are disengaged or sound angry? Was it a difficult day in clinic? Lately, it seems like all the practicing physicians with whom I work are stressed every single day, which makes it hard to take projects forward when you need their input. I’m seeing many more canceled and rescheduled meetings and lots of schedule juggling. I’m having to think of entirely different ways to work with some of my end users while they struggle to balance all of the different pressures that they are under.

Lately it seems like they never get a break. The younger clinicians seem particularly stressed because school is starting soon. Most of them have planned for their children to attend in-person school, and the thought that our local COVID case numbers might change that is pushing them to the brink. It’s hard to get people to want to engage with you around designing order sets or evaluating potential clinical workflows when they are worried about childcare. We’ve seen a drop-off in participation in some of our committees and work groups as well. It seems people are just not willing to spend any more time at the workplace than they absolutely have to.

It doesn’t seem like video calls are the answer due to a tremendous amount of Zoom fatigue. We are having to think outside the box on how to engage people while also respecting their need for work/life balance. It’s important that we have good representation from different types of users with different types of needs, so we’re going to have to figure it out.

As clinical users become more stressed by patient care activities, they have less tolerance for misbehaving technical systems. What used to be small annoyances that users would ignore now seem to be more disruptive. If the EHR is running slow or there are any performance lags, it causes much more angst. Any buffer of resilience has been completely eroded over the last year. Most of the clinical organizations I work with have placed new non-essential tech initiatives on hold in order to give their budgets some breathing room, and it’s probably a good thing because it also gives their personnel some breathing room. For those that are moving ahead with big projects, I’m making sure they think about how they’re going to best support their users through the transitions.

I’m curious how other organizations are coping with the stresses of our new healthcare normal. Maybe there are some change leadership Jedi tricks that I haven’t learned yet that would be of benefit. Or perhaps the solution is to just slow down and give people some breathing room so that they can focus on patient care and self-care. Or maybe there are no good answers, and we just have to continue putting one foot in front of the other each day and hope for the best.

How gritty are your clinicians, and will they be able to rebound? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Vik Krishnan, GM, Intrado Digital Workflows

July 26, 2021 Interviews No Comments

Vik Krishnan, MBA is general manager of the Intrado Digital Workflows business of Intrado Life and Safety.

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Tell me about yourself and the company.

I live in Boston with my wonderful wife and three children. I studied biomedical engineering at the University of Pennsylvania, then earned my MBA from Harvard Business School. I entered the digital health market 12 years ago through a company I founded. I have the probably unique distinction of having run two of the businesses in the market today that offer something similar to Intrado HouseCalls in terms of patient engagement.

Intrado’s HouseCalls business is a market share leader by far in automating mass patient engagement workflows. We serve 17,000 healthcare providers, including 400 of the largest hospitals that are using Epic and hundreds that are using Cerner.

Dental practices have offered just about every form of patient engagement technology for years. Why did it take practices and hospitals so much longer?

If you think about the longer tail of healthcare providers, small physician practices and dental practices, there is no disguising the revenue impact in a given week or in a given month of even a slight variation in patient volumes. A dental clinic is going to feel that. They may even go under with a couple of bad months. That’s probably why they were quicker to adopt. Also, any smaller institution in any market, including healthcare, is usually more willing to have a quicker and more simple sales cycle. There are more levels in the decision and more integration into the solution and the current systems at a larger healthcare provider.

All of those factors will come into play. I think that they have gotten there now, though, but you are right, it has taken longer.

What do patients gain as a benefit when you integrate a patient engagement platform with an EHR like Cerner or Epic?

We have to understand patient preferences. Certainly they vary by demographic type, and age, but essentially what a patient is looking for is a seamless experience. Surveys find that 90% of patients want automated patient engagement communications. Nearly 70% say that they want more communications and reminders that help them be compliant with their own healthcare needs and their own requirements.

What they don’t want to do is get a reminder — for example, about an appointment — and then realize that the scheduled time doesn’t work for them, but the only available follow-up action is to call the contact center. That’s a laborious process, not just for appointments, but for a recall campaign, for example. If somebody knows that they need to schedule an annual wellness visit, but now they have to call in and wait, that’s a challenge and a burden that can ultimately disengage the patient from the process.

What a patient would like — and this can only be achieved through deep integration with the EHR – is to solve that workflow through SMS. If the appointment I have tomorrow doesn’t work, why can I not just reschedule that through SMS through real-time integration with the EHR? If I know I need a colonoscopy and I’ve been reminded of it effectively, that’s great and I want to schedule it, too. Why can’t I just do that in an automatic way without talking to a human being?

Last point on this. This matters a lot for underserved communities as well, because there are a variety of differences to consider there. Some of those differences are around a preference that studies suggest for using SMS versus phone call and email. Some of it is around language. If a platform can use over 100 languages, you are more likely to deliver the patient experience that somebody wants if English is not their native language. That will improve communication health and patient satisfaction.

How do you capture the categories into which a given patient falls, such as those with a preferred communication method, a limit to how many messages they want to receive, or those who want to opt out entirely?

That is done effectively through both a solution philosophy and a support philosophy. The solution philosophy needs to be to use the hospital or health system’s EHR as the single source of truth. If the hospital or health system is using the EHR as a single source of truth, these toggles, these preferences, this information will be in there. It’s just waiting to be used.

Then the next step is a solution philosophy that leverages that data, integrates through real time like we do through APIs into the system, and is empowers that system and that hospital to get the most out of their EHR. Any hospital CIO or CMIO will tell you that they want the EHR to be the single source of truth. It’s harder to do that when many other solutions on the market don’t integrate through API as the way we do and instead use HL7. This creates a parallel EHR-like system of data and rules that live outside of the EHR.

That makes it more complex. It makes it harder for the hospital to manage this and these insights on the patients and their preferences. It also exposes the hospital and health systems — going a little off-topic here, but it’s important to mention — to data breaches and other risks. You use the EHR as a single source of truth, and you help through support the hospital or health system to do that. That’s ultimately how you achieve what I just described in my previous answer.

Everybody’s buzzword is “digital front door.” Do health systems that haven’t solved longstanding patient pain points – employee friendliness, parking and wayfinding, and accurate billing – create digital expectations that their physical reality can’t match?

We see a lot of hospitals navigating what seems like a simple concept. Digital front door seems like a specific concept, just like patient engagement seems like a specific concept, but ultimately it involves a more comprehensive solution with lots of departments and stakeholders at the hospital involved. We typically see hospitals and health systems find this process, both front door and digital engagement, to be complex and difficult.

The concept of digital front door can encompass many things. It could encompass what the website looks like. Is there a chat bot or web bot on the website? That’s for inbound. Patient engagement is often thought about as being outbound, but the way we think about it is two way. We want to facilitate, and we do, two-way patient interactions. Sometimes these will be around something specific that is happening. We want to inform a patient about an annual wellness visit, the need to get a mammogram, or something pre-post-procedure, appointment, or thereafter. But sometimes these things will be inbound. It’s not because of something the hospital wants, it’s because of something the patient is seeking. They may be on the hospital’s website, for example, and want to be able to take an action that doesn’t involve calling the hospital contact center.

We see complex RFP processes. We see hospitals engaging consulting firms to solve these problems. I certainly have recommendations on how to solve these problems, but I want to acknowledge it is a complex process and decision that is difficult for hospital decision-makers to navigate.

Is it possible to address all these patient needs, including pre- and post-procedure instructions and communication with the patient’s family, through a single technology or vendor?

It is. This is an important concept to mention. We see an evolution underway right now in the market in terms of how hospitals and health systems are viewing patient engagement. Virtually all understand that they need to send SMS reminders, for example, about appointments and related communications. Many today still view those particular use cases as point solutions, or value may be measured, for example, through no-show rates or through transactional pricing.

Some, to your point, have understood that they need a patient engagement platform, not a point solution. More broadly, a solution, a platform that is not just solving any one of those things, but that integrates, for example, in real time, not just with their EHR, but with other systems like the contact center. One that truly automates a wide range of two-way patient engagement workflows.

When you think about making a solution decision versus a platform decision,vit can be a more complex decision. But the ROI for that platform will be measured by increased revenue delivered, decreased operational costs that the hospital has to bear, and increased community health and patient satisfaction. Some hospitals and health systems are going through that process, and that frankly is the solution that we provide. Those are the types of customers that we serve and the needs we try to solve, but that’s how you get there, and that’s the difference between the solution and the platform.

To what degree are hospitals using patient-reported outcomes, such as automating a daily inquiry about the patient’s pain, medication effectiveness, or mobility?

Let’s talk about a mass notification solution and then a patient engagement platform and what the difference is.

Let’s say a hospital has a mass notification system to inform patients about the need to have an annual wellness visit. They have some success rates. Great. They get some revenue and community health has improved. Nice job.

Now if they have a patient engagement platform that truly integrates in real time, it can automatically identify which patients need to be informed about an annual wellness visit. It can drive those interactions, but it can also capture those patients, for example, who say, “I actually declined, I don’t want to have an annual wellness visit.” You can record that information and report it in real time back to the EHR.

At some point, that patient will come in and  talk to a physician, maybe their PCP, about something else. The PCP, through a platform — not just a mass notification system — will have that information in the EHR that will allow them to know the decision the patient made and have a conversation with them about why they made that decision. This is about holistic care, which ultimately drives patient satisfaction and improves community health. Doing that actually also improves the hospital’s satisfaction scores and care quality scores, just knowing why if somebody didn’t want to do something, why that was and what happened after.

Do health systems and practices do a good job of not overwhelming patients with poorly designed or poorly targeted messages?

For our solution, we adopted a concept of augmented intelligence. You can broadcast every message to every patient about everything, which will probably create the dissatisfaction and disengagement that you just described. You can also ask a patient to go log in somewhere to a portal, download an app, and go log in there and get whatever information that the hospital wants the patient to get. Every study shows that if you ask a patient to log in somewhere, they’re less inclined to do it. They probably don’t know their login and they will never get that message. The message may not even be tailored to them.

An augmented intelligence patient engagement platform integrated into the EHR knows when a patient needs to hear what and when. Once one of those automated workflows is set up by hospital staff, it runs. It can be monitored and reported on, but it doesn’t need to be manually managed. A platform like that will reach out to patients about the right thing at the right time and collect responses. That makes it more tailored, more personalized, and ultimately more effective.

What changes do you expect to see in your business over the next few years?

We have adopted a process of continual innovation. The biggest hump to get over — and we are increasingly doing this in our new logo deals and also our customer base —  is that it’s not a point solution that you need. What you’re getting from us now and what you need to adopt from us now is a true augmented intelligence patient engagement platform.

But once they make that leap, and many of our customers already have made that leap with us, then it is not hard after that to continue to add new workflows that increase automation and ultimately help healthcare providers, hospitals, and health systems do three things — increase their revenue, decrease their operational burden and costs, and improve community health and delight patients and increase their satisfaction. Once the customers we serve and the customers that we are adding are over that hump, they will continually add more and more automated workflows that we are delivering.

Do you have any final thoughts?

I’ve described the concept of a point solution and a platform. While we excel at delivering some of those point solutions, our mission in this business is to offer the platform. If a healthcare provider in your audience is interested in a true platform that digitally transforms their organization and does what I’ve described, I would urge them to reach out to Intrado or to me personally.

Morning Headlines 7/26/21

July 25, 2021 Headlines No Comments

Sema4 Closes Transaction with CM Life Sciences, Debuts as Publicly Traded AI-driven Genomic & Clinical Data Platform Company

Clinical data and genomic platform vendor Sema4, a Connecticut-based venture of Mount Sinai Health System, goes public via a SPAC merger at a valuation of around $3 billion.

System C buys medicines management specialist Wellsky

British health IT company System C acquires medication management vendor WellSky International.

Caregiver Support Company Cariloop raises $15 million in Series B funding to expand help for families and ease caregiving crisis

Digitally-enabled caregiving support company Cariloop raises $15 million in a funding round that brings its total raised to just over $24 million.

UPMC reaches $2.65 million settlement with employees over data breach

UPMC will pay $2.65 million to settle a class action lawsuit that charged it with failing to protect employee information that was stolen and used in a phony tax refund scam.

Monday Morning Update 7/26/21

July 25, 2021 News 4 Comments

Top News

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Clinical data and genomic platform vendor Sema4, a Connecticut-based venture of Mount Sinai Health System, goes public via a SPAC merger at a valuation of around $3 billion.

A health IT connection is President and COO Jamie Coffin, PhD, whose history includes time with Dell and IBM.


Reader Comments

From Exit the Kraken: “Re: HIStalk fan club on LinkedIn. Seems like a lot of company promotion going on there.” Some of the HIStalk “fans” use the group to pitch competing sites or advertise their non-supporting companies in a way that seems distasteful, but I guess that’s the nature of PR-seeking LinkedIn users. I’ll take it as a compliment that my readership is larger and more influential to the point that folks abandon their pride in an attempt to reach it.


HIStalk Announcements and Requests

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Poll respondents expect Amazon to be the strongest healthcare market participant in the tech world, although I probably shouldn’t have listed it among pure tech companies since their competitive advantage mostly lies elsewhere. Eddie T. Head throws down the “you heard it here first” gauntlet in boldly speculating that the winner will be Oracle after they buy Cerner.

New poll to your right or here: Who is most responsible for the VA’s Cerner rollout challenges?

I didn’t get many responses to my inquiry about folks who had planned to attend HIMSS21 but recently changed their mind, which may or may not mean that there aren’t many of them. A couple of folks say their employer has banned travel, a mom who is breastfeeding her new baby and would have had to bring them along says it’s not worth the exposure given the rise in the Delta variant, one says they fear being infected even with vaccination even though it likely wouldn’t be fatal, one is under UK travel restrictions, and one says they won’t give personal information such as vaccination status to HIMSS.

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Meanwhile, hospitals in Las Vegas – along with those in other low-vaccination states like Missouri, Florida, Louisiana, and Arkansas — say they are straining with high numbers of COVID-19 patients, most of them young and unvaccinated. Cases in Clark County have jumped fivefold in the past month and hospitalizations are reaching peaks that approach last year’s summer surge. Only 39% of county residents are fully vaccinated. That number is almost certainly underestimated since it would not include the many visitors who unknowingly take the virus home during its 2-14 day incubation period.

The challenge for HIMSS is that unlike in Orlando, the Las Vegas conference areas cannot be secured from unvaccinated outsiders since hotels were intentionally designed to force people to pass through the casinos to reach conference areas, guest rooms, and restaurants. Still, that incidental contact is unlikely to support respiratory spread, so the danger zone is outside the cordoned off HIMSS21 areas where exposure is extended (bars, restaurants, casinos, shows, etc.) Vaccinated attendees are unlikely to become infected and any breakthrough infections should be mild, but while vaccinated people are less likely to spread COVID-19 to some unknown but likely significant degree, hospitals may decide the risk isn’t worth it for their employees and keep them home.

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The security membership group ISC West just wrapped up its conference at the Sands Expo & Convention Center (which, by the way, will be renamed to The Venetian Expo on September 2) with about 11,000 attendees – less than half the usual number – so we will see if any superspreading is reported (actually, it’s unlikely to be detected since contact tracing just isn’t done here). That conference did not require vaccination proof or masks – video from there (above) shows basically nobody masked — and instead relied on the usual pointless hygiene theater of obsessively disinfecting surfaces and pushing hand sanitizer after checking temperatures at the door.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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


Acquisitions, Funding, Business, and Stock

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Digital front door systems vendor Qure4U raises $25 million in funding.

CHIME’s fall healthcare CIO boot camp will be held in San Diego October 23-26. I should interview a freshly graduated participant one of these days since I suspect people who haven’t worked as an IT executive would find the content interesting.


Announcements and Implementations

UPMC will pay $2.65 million to settle a class action lawsuit that charged it with failing to protect employee information that was stolen and used in a phony tax refund scam.


Sponsor Updates

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  • Pivot Point Consulting sponsors and participates in the Wellspan York Health Foundation Benefit Golf Tournament.
  • Fortified Health Security releases a new video, “Cyber Insurance Requirements Have Changed. Are You Prepared?”
  • Authority Magazine interviews Nordic Advisory Services Practice Lead John Distefano.
  • The HIMSS Podcast, “What We Learned About Health IT During the Pandemic,” features PatientKeeper VP of Product Management Cathy Donohue.
  • Pure Storage expands as-a-Service offerings designed to support business outcomes.
  • RxRevu publishes a new whitepaper, “How Accurate Prescription Data Can Drive Valuable Decision Making at the Point of Care.”
  • Masstricht University Medical Center, Laurentius Hospital, and VieCuri MC in the Netherlands jointly select Sectra’s digital pathology solution.
  • Spok releases a new video, “Go ‘beyond’ secure texting in healthcare.”
  • Tegria publishes a new case study featuring Val Verde Regional Medical Center and Engage’s work to implement a remote-hosted EHR during COVID time pressure.
  • Waystar appoints former JP Morgan executive Heidi Miller to its Board of Directors.

Blog Posts


Contacts

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

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Weekender 7/23/21

July 23, 2021 Weekender 1 Comment

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Weekly News Recap

  • The VA tells the House Veterans Affairs Committee that it won’t bring any more sites live on Cerner for at least six months.
  • A law firm files an information blocking complaint against a hospital, Meditech, and Ciox Health, claiming that it could not get a machine readable PDF of a client’s medical records.
  • WebMD acquires The Wellness Network
  • The New York Times says IBM Watson failed to achieve its goals of business transformation and IBM rejuvenation, noting specifically that Watson’s healthcare “moon shot” failed in multiple health systems.
  • The Senate confirms as VA deputy secretary Robert Remy, JD, whose job responsibilities include overseeing its Cerner project.
  • A study of 500 hospital websites finds that 471 of them have not posted their prices as federal transparency rules require.
  • Clinical data and registry vendor OM1 raises $85 million.
  • As HIMSS21 approaches, a COVID-19 resurgence in Las Vegas causes the Venetian, Palazzo, and Sands to again require employees to wear masks.

Best Reader Comments

If the insurance company maintains the same standard of what is medically necessary, then won’t eliminating prior authorization translate directly into increased denials? … It seems like the law ultimately makes things more convenient for providers and shifts the burden of fighting insurance companies to patients. (IANAL)

Having worked at one of the four start-ups that IBM purchased and then destroyed, it’s prime material for a case study. Bringing in IBM resources (including senior IT) that couldn’t spell healthcare and were now in charge was the beginning of the end. No ability to focus on the right problems, selling software that didn’t exist, making promises that were impossible to fulfill, etc. (tchips)

I have been an IBM “partner” in two companies, a position I would not wish on my worst enemy. “Their clients are their clients, and my clients are their clients” type of attitude. Ever since introduction 20+ years ago, I kept saying that Watson was a hammer looking for a nail. The main premise was its use in diagnostics, and I’m sorry, but well-experienced and well-read physicians can achieve similar or better conclusions than the box with the blinking lights, which at best could only suggest possible diagnoses.(Dr. Moriarity)

I think HIMSS will ultimately be at the whim of the hospitals. Should they universally re-enforce travel bans (if they haven’t already), the vendors will catch wind of it and a few of them will seize the moment as a PR opportunity to make a splashy statement about why they’re pulling out this year … Hopefully it won’t come to this and we can all enjoy the annual industry soirée safely, but I think it’s fair to say we’re beginning to see some cracks in the foundation. (LongTimeFan)

I can see imaging solutions being close to being ready [for IBM Watson-like solutions]. With a plethora of training material associated with a diagnosis, the solution could train in pretty good order. But how are you going to train it to practice oncology? (Brody Brodock)

There’s also only one vendor that can deliver basic interop out of the box with very little effort, and even richer interoperability with a some terminology mapping. Kind of sad that this project [the VA’s Cerner implementation] is doing so poorly in this area when that is allegedly why Cerner won out. (Elizabeth H. H. Holmes)

[Penalties for hospitals failing to post prices] shouldn’t be about the dollar value. If you operate in the United States, you should do your best to follow the law. What you’re seeing here is widespread malfeasance by health systems. Regulators should come down hard on them in response. (IANAL)

[IT projects reducing cost] is a goal, I think it’s somewhat dangerous to assume this in every single instance. Personally, I’ve long said that these EMR/EHR implementations often raise expectations of what can be accomplished. And those raised expectations sometimes increase rather than decrease costs. Expectations are a matter of politics. Thus, regardless of what the budget said, you may find expenditures beyond the budget. It only takes a sufficiently highly placed executive to demand that their expectations be met. (Brian Too)

Large scale project PM’ing 101 – never, ever put the software vendor in as the prime on any large contract. Especially when it involves large-scale systems integration with all kinds of third parties. At least VA is seeming to acknowledge that end goal. (John Bob


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. D in Nebraska, who asked for COVID-related sanitation supplies and health books for her Head Start class. She reported in December, “As this fall has been full of uncertainty, we have had to shift learning styles several times, but having the items from this project in my classroom has given me a small peace of mind that the kids will be safer and healthier thanks to you. Most of all, the air purifier is such a blessing. This purifier has a setting that our classroom air is recirculated once per hour. This helps myself and all the parents to know that the germs are being filtered out. Thank you doesn’t seem like enough to say, but know your generosity has definitely not gone unnoticed.”

A ProPublica review finds that 40% of the employees of nursing homes and long-term care organizations have not been vaccinated against COVID-19, which killed huge numbers of those residents before the vaccine became available. Twenty-three facilities reported vaccination rates of under 1%.

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A North Carolina doctor is named as one of the “Disinformation Dozen” who are responsible for 73% of the anti-vaccine content on Facebook. Rashid Buttar, DO posts conspiracy theory videos claiming that COVID-19 vaccines cause infertility and that wearing masks and 5G cell networks cause COVID-19. Some of the videos to which he linked generated commissions for himself. The doctor has been reprimanded twice for unprofessional conduct and cited by the FDA for illegally marketing unapproved drugs. It would be interesting to fact-check his CV, which lists impressive educational, military, and athletic accomplishments before he specialized in chelation therapy.

A Colorado couple will pay $5,000 more than they expected for the birth of their son under the 1970s-era “birthday rule,” which says that when parents have separate health insurance plans, the delivery cost is covered by the policy of the parent whose birthday falls earlier in the year. That is the husband in this case, whose lower-paying insurance has forced the couple to sign up for a three-year payment plan.

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Like a flight whose seats are oversold, a UK medical school offers accepted students $14,000 and a free first year of rooming if they will defer their high-demand spot for a year.

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A 96-year-old woman who is believed to be the oldest working nurse in the country retires from MultiCare Tacoma General Hospital after a 70-year career. The advice of now-retired OR nurse Florence “SeeSee” Rigney to fellow nurses is “don’t ever think that you know it all.”


In Case You Missed It


Get Involved


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Morning Headlines 7/23/21

July 22, 2021 Headlines No Comments

Moving Forward: Evaluating Next Steps for the Department of Veterans Affairs Electronic Health Record Modernization Program

The VA tells the House Veterans Affairs Committee that it won’t bring any more sites live on Cerner for at least six months.

Achieve Partners Backs Healthcare IT Provider to Launch Major Apprenticeship Program

Achieve Partners, which invests in skills development technologies and businesses that can create American jobs, acquires staff and consulting services vendor Optimum Healthcare IT.

Imprivata Adds Privileged Access Management (PAM) to Industry-leading Digital Identity Capabilities by Acquiring Xton Technologies

Imprivata acquires Xton Technologies and will incorporate its privileged access management solutions into its digital identity framework.

Qure4u Announces Close of $25M Growth Equity Investment to Accelerate Innovation in Digital Health Solutions

Qure4u, which offers automated patient intake, engagement, and virtual care services, raises $25 million in a funding round led by Volition Capital.

News 7/23/21

July 22, 2021 News No Comments

Top News

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The VA tells the House Veterans Affairs Committee that it won’t bring any more sites live on Cerner for at least six months. From the hearing (in addition to misstating the Eastern time zone as “EST” above):

  • Rep. Matt Rosendale (R-MT) said that despite the VA’s assurance, “we’re going to find out the proof is in the performance. If the army of crackerjack management consultants, and tiger teams, and advancement teams, and adoption coaches, and change management experts can’t make headway with the situation in Spokane, the reason is probably pretty simple. The software just isn’t any good, folks. Either that or it isn’t good for the VA.”
  • VA OIG told the committee that VA’s modernization committee reported that 89% of users passed proficiency tests with a score of at least 80%, but OIG found an earlier draft stating that just 44% passed at that level, indicating that the report was altered before submission. The VA says it will consider disciplinary action if its investigation shows it to be warranted.
  • Acting Deputy Secretary Carolyn Clancy, MD told the committee that “we will not be scheduling any deployments in the next six months” as the VA reviews infrastructure requirements and develops a new rollout schedule that will be driven by site readiness.
  • Rep. Mark Takano (D-CA) expressed skepticism that the VA gave Cerner the minimum passing grade of “satisfactory,” questioning whether it did so just to avoid having the contract cancelled.
  • Rep. Jim Banks (R-IN) expressed frustration with the project’s overall cost, noting that VA OIG’s list of missed items could swell the budget to $21 billion and also recalling that former VA CIO Roger Baker originally gave a number of $30 billion. The original project estimate was $10 billion.
  • The VA is reviewing Cerner’s patient portal and its contractual obligations, with Dr. Clancy predicting that the end result will be a combination of Cerner’s product and the aspects of My HealtheVet that veterans like.
  • Rep. Rosendale pressed Cerner executive Brian Sandager on why Cerner’s bid was so far off the mark even though the company was the sole-source bidder and thus the presumed expert. Sandager blamed changing requirements and lack of access to VA staff because of the pandemic.

Reader Comments

From Banned Book: “Re: Cerner. Seems like a lot of execs are moving on lately.” Maybe, but Cerner is a huge, publicly traded company with deep talent, and some of those folks have been around long enough to realize that maybe they’ve peaked at Cerner and need to move out to move up. The lackluster company performance over the past few years that led to Brent Shafer’s announced departure and his uncertain replacement is likely accelerating the exodus. I don’t think it’s necessarily a poor reflection on the company or an indication of executive dissent – it’s a hot health IT market out there and well-funded startups need some adults in the room.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Upfront Healthcare. The Chicago-based company navigates patients to the care they need as new digital services, sites of care, and non-traditional competitors reshape the way they expect to interact with their health system. The company delivers superior outcomes through personalization, in which advanced analytics is used to adapt communication channel and content to eliminate barriers to patient engagement. The frictionless experience requires no download or login as it guides patients to the services they need to close care gaps, attend visits, reschedule in a single click, enroll in services, improve medication adherence, follow up after a transition of care, prepare for an episode of care, and schedule open referrals. It provides the contact center and care team with a unified view of patient communications for all modalities (SMS, email, digital voice, etc.) and can be launched from the EHR or CRM with integration using API, HL7, SMART on FHIR, and batch files. Co-founder and CEO Ben Albert, MBA is an industry long-timer who founded what is now Crimson Care Management. Thanks to Upfront Healthcare for supporting HIStalk.


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Were you planning to attend HIMSS21 but have changed your plans in the past couple of weeks? Tell me why. The beginning of the end for HIMSS20 was companies – including health systems – that banned travel due to the alarming rise in COVID-19 cases and readers keep asking me if that could happen again.

If you attend HIMSS21 in person instead of watching the virtual version, you’ll miss the virtual-only keynote of “Grey’s Anatomy” star and TV doctor Patrick Dempsey. His credentials are a bit shy of being a real doctor — he dropped out of high school to join the circus, and once he became famous on TV years later, his high school just gave him the diploma he didn’t earn.

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Dann Lemerand, who started the HIStalk Fan Club on LinkedIn in mid-2008, says it has 4,000 followers. I can’t make a strong argument for joining since you don’t get anything for doing so, but at least you’ll be rubbing virtual elbows with some pretty high-level industry folks who signed up. I really should review my LinkedIn connections and recommendations for an emotional lift in those moments where I question the wisdom of sitting in an empty room filling an empty screen.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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


Acquisitions, Funding, Business, and Stock

Staff and consulting services vendor Optimum Healthcare IT is acquired by Achieve Partners, which invests in skills development technologies and businesses that can create American jobs. Achieve will expand Optimum’s paid health IT apprenticeship program.

Imprivata acquires Xton Technologies and will incorporate its privileged access management solutions into its digital identity framework.

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Bon Secours Mercy Health makes an unspecified investment in healthcare analytics vendor Trilliant Health.

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Digital health vendor B.well Connected Health raises $32 million in a Series B funding round, increasing its total to $59 million.


Sales

  • Health engagement company Higi chooses Ellkay for platform integration with its healthcare partners.
  • Laboratory data integration services vendor Diagnostic Support Services chooses Lyniate Corepoint to enable advanced interoperability.
  • Winton Hills Medical & Health Center (OH) selects Emerge’s ChartGenie data conversion solution for its move to Athenahealth along with the company’s ChartScout and ChartPop products.

People

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Ted Pfeiffer, MBA (Sg2) joins healthcare consulting firm The Greeley Company as VP of product innovation.

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Syntellis Performance Solutions, the former Kaufman Hall software division, names Flint Brenton (Centrify) as CEO. He replaces Kermit Randa, who will leave the company now that it has been taken independent with investments from Thoma Bravo and Madison Dearborn Partners.

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Mike Nill (Cerner) joins Rx Savings Solutions as strategic advisor.


Announcements and Implementations

Vocera announces Edge, a cloud-based clinical communication and collaboration solution for smartphones.

Google Cloud offers a private preview of Healthcare Data Engine, which creates real-time views of longitudinal patient records. The company says the product can map 90% of HL7v2 messages to FHIR out of the box.

Canon Medical Systems will rename its health IT division, which includes Vital Images, to Canon Medical Informatics.

Document Storage Systems (DSS) launches a commercial division called Juno Health, which will offer an EHR and solutions for e-prescribing and emergency services.

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Highlights from the just-issued “Semi-Annual Market Review” of Healthcare Growth Partners, which as usual drew me in to read every word instead of the quick skim I envisioned:

  • The company estimates that digital health company valuations have risen 30% since the pandemic began, with high-performing companies seeing even bigger premiums.
  • M&A is on track to jump 43% this year, while investment value is on pace to rise 85%.
  • HGP sees four factors driving this activity: excess financial market liquidity, impending increases in the capital gains tax, the obvious appeal of digitizing and virtualizing healthcare, and the fear of missing out (buyers) and of losing it all (sellers).
  • SPACs are popular with lower-revenue companies and share price of those less-mature companies is more volatile due to their appeal to inexperienced investors and lower share supply. Digital health IPO stocks have increased significantly in price, while SPAC stocks trade below offer price on average.

Government and Politics

A Georgia law firm files an ONC information blocking complaint against Doctors Hospital of Augusta, Meditech, and Ciox Health, claiming that the patient records the firm requested on behalf of its malpractice client were not provided as an OCR-readable PDF file.

ONC seeks feedback on use of the HIPAA Security Risk Assessment tool.


Other

Rep. Marjorie Taylor Green (R-GA) tells a reporter who asked if she’s been vaccinated for COVID-19 that the question is “a violation of my HIPAA rights.” She is likely not the only member of Congress who thinks HIPAA is something it isn’t.

University of Vermont Medical Center discloses how ransomware took its systems down for a month and cost it at least $50 million – an employee took a hospital laptop on vacation and used it to open an email from their homeowners’ association, which had been hacked and whose email contained malware. When the employee came back to work and connected to the hospital network, the malware was spread.

HIMSS says it expects a smaller attendance for HIMSS21 than in previous years, but says that paid professional attendance has reached 75% of the 2019 total. First-time attendees make up 40% of the total registered. The exhibit hall will host 750 companies, 200 of them first-timers. HIMSS says that it is “mindful” of COVID-19 case numbers and recognizes that some registrants may not be able to attend due to various travel policies. A conference update says that all venue and hotel staff will be masked per recent Southern Nevada Health District guidance, while masks are encouraged but not required on the HIMSS21 campus since attendees must prove they’ve been vaccinated to enter.


Sponsor Updates

  • InterSystems announces that Forrester has recognized its Iris data platform as a leader in “The Forrester Wave: Multimodel Data Platforms, Q3 20201.”
  • Wolters Kluwer Health releases the second edition of its “Future of Technology in Nursing Education” survey.
  • EClinicalWorks releases a customer success video featuring Zeid Medical Group, “Using Prisma and Interoperability for Better Records.”
  • Upfront Healthcare partners with Firstsource to offer personalized patient navigation.
  • Redox launches an Amazon HealthLake Connector offering and announces its support for the Amazon for Health initiative.
  • Healthcare IT Leaders, BD, and TrackMy Solutions provide COVID-19 testing services and support to Camp Barney Medintz.
  • Fortified Health Security releases its “2021 Mid-Year Horizon Report.”
  • Goliath Technologies publishes a new case study, “Central Maine Healthcare Drastically Reduces Citrix & Cerner Clinician Time to Remediation.”
  • Healthcare Growth Partners advises MDTech in its sale to EverCommerce.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 7/22/21

July 22, 2021 Dr. Jayne 4 Comments

When I was deep in the primary care trenches, I used to fantasize about insurance companies that would allow you to skip their prior authorization process if your track record had no previous denials. That might become a reality in Texas, as a recently passed law takes effect this fall in which physicians who have a certain track record can be exempted from prior authorization process. They will need to demonstrate that 90% of their treatments in the previous six months met payer criteria for medical necessity. Now we’ll have to see whether EHR vendors update their clinical decision support algorithms to capture whether a physician has to deal with prior authorizations or not. Still, it’s a victory for patients who won’t have care delayed and for physicians who can reduce overhead spent on needless bureaucracy.

I’m lamenting the fact that both of my local medical schools have apparently decided that the pandemic is over, canceling virtual access to Grand Rounds and other presentations. For those of us who practice in the community or who aren’t near the medical campuses, being able to attend sessions from a distance was a tremendous boost. I attended more lectures in the last year than I had in the previous five years. Hopefully, some of my out-of-state sources will continue offering virtual options.

I admit that sometimes trying to do a virtual / hybrid offering can be challenging, but at a minimum they should record the sessions and allow people to access them later. They’re already doing those kinds of recordings for medical school lectures (and had been doing so long before the pandemic) so the technology is largely in place. Why wouldn’t you want to get your message to as many physicians as possible? Seems puzzling to me, but maybe some readers have more insight.

Surgeon General Vivek Murthy takes aim at health misinformation this week, urging communities, health professionals, and tech companies to help patients understand the reality behind COVID vaccines, treatments, and overall status of the disease. His call to action takes the form of a Surgeon General’s Advisory like those that were used in the past to address smoking and other serious health threats. The document calls on researchers to better qualify the damage done by health misinformation. It also calls on tech companies to monitor misinformation and to protect health professionals from harassment.

Banner Health is on the naughty list with many of its employees this week for issuing a commemorative coin to those who supported the health system’s pandemic efforts. A Banner spokesperson stated they hope it “will be a reminder in years to come of what we were able to achieve together during this once-in-a-lifetime event.” This rings hollow because we’re certainly not out of the woods yet and their putting the efforts in the past tense doesn’t reflect that many of the impacted workers are still grinding it out in the trenches as COVID infections keep rising. Also, some of us don’t want to remember what it was like in the worse parts of the year, because it gives us great anxiety and increases our stress levels. I’d be interested to see the statistics on whether the coin ended up in a random junk drawer for employees or whether it went straight to the trash.

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HIMSS21 is trying to lure attendees to its digital edition with Dr. McSteamy himself. One of my shoe-loving BFFs clued me in on the advertising campaign, noting “who at HIMSS thought it would be better to highlight an actor overall those other great speakers?” I get the philanthropist angle, but I’m guessing they went for the eye-candy factor, since the rest of the lineup includes healthcare leaders, innovators, and CEOs. I didn’t even get the email hyping Patrick Dempsey’s participation, so thanks again for keeping me informed. For those with more insight into the whole HIMSS21 situation, I’d be curious to hear your anonymous reports about the truth of registration numbers or the proportion of attendees who plan to participate in-person versus digitally. Everyone I’ve reached out to is being tight-lipped about the registration numbers.

Now that he’s not busy with Haven — the defunct effort by Amazon, JPMorgan Chase, and Berkshire Hathaway which failed at fixing healthcare like so many others before it — Atul Gawande, MD is being nominated for assistant administrator for the United States Agency for International Development’s (USAID) Bureau for Global Health. Gawande will need to be confirmed by the Senate, but tweeted that “With more COVID deaths worldwide in the first half of 2021 than in all of 2020, I’m grateful for the chance to help end this crisis and to re-strengthen public health systems worldwide.” USAID is tasked with advancing US interests abroad, but I sure hope there is a focus on advancing public health systems within the US. They’re under attack, and if anyone doesn’t believe we’re headed towards a dystopian universe, check out what’s happening in Tennessee, where the legislature has bullied the Department of Health into stopping vaccine outreach for teens, even for flu shots or other proven lifesaving vaccines.

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I spent a few days out of town this week and was happy to be somewhere less-COVIDy than my home state. In case you’re interested, free vaccinations are available at the Orlando airport. The US has already administered 337 million doses, with 161 million individuals being fully vaccinated. With everyone unmasking these days, it’s clear to most of us in healthcare that vaccines are going to be the only way out of this thing without an ever-climbing body count. We are now almost a year past when the Pfizer clinical trial started, with more safety data in the first year of this vaccine than any vaccine in the history of vaccines. If you’re still holding out, remember this: your choice isn’t necessarily between vaccine and no vaccine. Unless you’re going to stay in your house with no visitors or wear a delightfully snug N-95 mask everywhere you go, it’s more likely that your choice is between vaccine and COVID-19. Let’s fight this thing, folks.

Email Dr. Jayne.

Morning Headlines 7/22/21

July 21, 2021 Headlines No Comments

Carbon Health Secures $350 Million to Expand Omnichannel Primary Care Nationwide

Tech-enabled primary care company Carbon Health raises $350 million in a funding round led by Blackstone.

B.well Connected Health Secures $32 Million to Accelerate the Digital Transformation of Healthcare

B.well Connected Health, developer of health management apps for consumers, patients, and employees, raises $32 million in a Series B funding round.

CarePoint Health Opens Doors to Healthcare Innovation Center

CarePoint Health (NJ) opens a Healthcare Innovation Center within Bayonne Medical Center to bring clinicians, vendors, investors, and other collaborators together to develop new technologies.

HIStalk Interviews Don Woodlock, VP of Healthcare, InterSystems

July 21, 2021 Interviews 5 Comments

Don Woodlock is VP of healthcare at InterSystems of Cambridge, MA.

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Tell me about yourself and the company.

I have been in healthcare IT my whole career. I went to school next door to where I am now, at MIT. I joined the company IDX and worked there for 14 years building applications, basically billing, scheduling, and managed care. I joined GE Healthcare for 14 years doing imaging IT –radiology, cardiology, and labor and delivery type imaging. I’ve been at InterSystems for four years.

InterSystems focuses on two areas. One is a data platform. We have software companies, maybe most famously Epic, that build their applications on our technology. Then we have an interoperability product line called HealthShare that many of your readers would use. We have an EMR that we sell outside the US called TrakCare.

Northeastern companies such as InterSystems, Meditech, and IDX had a lot of influence on today’s health IT market going back into the 1960s and 1970s. What does that impact look like from the inside?

There’s a technology similarity, but the most important similarity — at least in the original IDX – is the private company, customer-obsessed model. Epic still has that, InterSystems still has that, and IDX had that while I was there. It was a small group of individuals who were really excited about health systems and were focused on that. They didn’t want to bring their companies public. 

That model and culture is familiar to me. I had a 14-year deviation when I went to GE Healthcare, but when I joined InterSystems, it completely reminded me of IDX, that same kind of friendly, customer-focused outlook. Maybe there’s a Boston-y culture to the whole thing. It’s a nice place to be.

Technologists from outside of healthcare may know little about Caché. Can you explain its benefits?

That market has come around a little bit more. This multi-model, key-value store wasn’t popular at all in the early days when the technology got started, and was not popular during the relational days. But in the last five to 10 years, there has been more variety in the way people see databases and different models. Caché’s power comes from this key-value model, which makes it scalable and efficient. You can build an application that scales and micromanage the way your data is actually stored. That’s part of Caché’s secret sauce.

How are the company’s integration and interoperability solutions used?

Our integration engine is used by 39 of the top 100 hospitals and health systems. Your readers may know it under the name Ensemble, but we market it now as HealthShare Health Connect. It translates from HL7 to FHIR to X12, from whatever format to another format. It scales really well and is the next generation of that category.

The broader HealthShare is a data aggregation, unified care record platform. It got started in the state HIE market a long time ago. We more often use it for health systems that want to aggregate data across all their different EMR systems. We also market it to payers, life sciences companies, and regional health authorities outside the US. It focuses on unifying patient data and making it useful for point-of-care, analytics, research, and many other use cases.

With interoperability, we are in the middle of a nice, big change from HL7 — which is more of a “copy data from here and put it there” model, that copy-and-paste model — to FHIR, where you have applications that can work together and can request information from each other. It’s a much better interoperability model and it also opens up a lot of innovation, where you can treat your EMR data as a FHIR repository and build applications on top of that more easily. We are at the beginning of a next era in interoperability that will be quite fruitful and useful to our industry.

What market exists for helping life sciences companies use provider EHR data for research, real-world evidence, and product monitoring?

We’ve had a lot of increased activity with life sciences companies. There’s the research side, which is running successful trials. Using real-world data helps you with study planning. I’m looking for diabetics over 50 on this medication — how many people can I find in my population that is used for site selection? What organizations should I approach to run my trials? Then there’s the patient recruitment process, having real-time interoperability of information so that my principal investigators at the different sites can identify patients as soon as they enter the system.

This market has been aided by more healthcare information being digitized. It has also aided by regulatory agencies that are more open to real-world data being part of a research submission.

Then there’s the commercial side. You have a drug or a therapy and you want to get it out to the market, so you need to understand that market. A broader array of data helps you understand where your patients live, what other medications they are on, and what other problems they have. Having this data enables a life sciences company to more effectively operate these days, and I think that most of pharma is recognizing that now.

How has product demand and the company’s strategy changed with healthcare’s move to the cloud?

The cloud enables innovation. On-premise is like our waterfall software development process, while cloud is more like agile, lean, and a minimally viable product. It enables you, as a health system that wants to innovate, to spin up a FHIR repository, spin up a development stack, and try a proof of concept. To build a small application and not necessarily have to have pre-thought all of that and to buy a lot of hardware. You can focus on that stable environment.

You can more easily innovate and adapt in a cloud-based environment. That’s in addition to operating a data center better and more effectively with a cloud partner. The interesting part of the cloud is the innovation and the ease of starting up and taking advantage of newer technologies.

Our predominant model of healthcare applications, like HealthShare, is to offer it as a service. Customers may choose on-prem, but generally speaking, most of our new projects are us managing the entire environment for a customer. Then we are starting to introduce cloud-based services. Earlier this week, along with Amazon’s launch of HealthLake, we launched our HealthShare Message Transformation Service, which allows HealthLake to speak HL7. You can see it in the AWS marketplace. You can spin it up today and start using it.

We anticipate that more and more of our offerings will look just like that. We’ll offer it in the cloud stores. Customers can spin it up and start using it. The amount of friction needed to get started with InterSystems technology will be lower.

Healthcare users may not be aware that InterSystems has customers in other industries.

InterSystems is a multi-vertical company. We have a lot of experience in healthcare, but we are building up a more robust financial services business. The majority of trades that happen in the US stock exchanges go through InterSystems technology. We have another interesting customer who is basically the NASA of Europe. The European Space Agency tracks all the bodies in the sky using InterSystems technology. We have a lot of neat customers in other verticals as well.

TrakCare is a fully functional EHR that is in the top three in the world. We sell in 28 countries. The root of that business was a customer of ours named TrakHealth in Australia that had built an application on our technology. We became closer and closer with TrakHealth and eventually acquired them and made them part of InterSystems. We have a big business in the UK, Italy, Australia, New Zealand, China, the Middle East, and Chile. We enjoy having a global EMR product, but having a level of what we call local editions that tailor it for these specific markets.

Would you ever develop or acquire domestic healthcare applications, or do you have agreements with customers such as Epic to avoid competing with them?

We don’t have an agreement, but we feel like the EMR market in the US is pretty well saturated and pretty well taken care of, including by our good partner Epic. We don’t have any plans to launch TrakCare in the US. I don’t think it would add a lot to the market, honestly.

It must be unusual for a company that is approaching $1 billion in annual revenue to be owned outright by a single person, Terry Ragon in the case of InterSystems. What are the advantages of that form of ownership and how does it influence the company’s long-term plans?

There’s nothing like the private company model when the company is profitable and doing well. I enjoyed my time in GE Healthcare, but you have this other stakeholder, which is the shareholder and quarterly earnings concerns. That’s another kind of stakeholder that you need to worry about, please, and perform for in addition to customers, which is this other sphere. That was the only sphere I ever cared about, honestly. It’s nice to be in a private company with the one owner. It’s a simple model, where I can focus on customers all day long and not really worry about the rest.

We don’t have any concerns about the long run. We haven’t made it a priority to figure out the long-run transitions. We’re happy now. My boss, the CEO and owner, comes in every day. I just met with him earlier. We have a fully staffed senior leadership team, a 1,600-person-strong company, and a great customer base. We are enjoying ourselves pleasing customers.

How will the company’s healthcare strategy change in the next few years?

We are migrating more and more to analytics. That is natural in our industry. We’ve collected all this data, we’ve digitized our workflows within health systems and providers, and now we want to get more out of that. A lot of our customers are migrating to using their data for analytics. The types of things we do around interoperability, data aggregation, and normalization are all useful for the analytics use case. We have been focusing on a lot of projects and offerings in that respect.

Even our underlying data platform historically has been that online transactional processing system, and more and more customers want to build analytics solutions on it. We’re adding a number of features around self-service analytics, Python, integration, and embedded machine learning, a number of things that are more analytics-oriented to our product line. That is a big part of the future.

The other would be what we talked about concerning cloud. Having more and more of our offerings be click-click services that you get in, start up, and start to use instead of larger decisions that involve a larger monolithic type of implementation.

Do you have any final thoughts?

It’s not InterSystems related, but I wanted to thank you for publishing HIStalk. I’ve been in health IT for 33 years and I have been a dedicated reader of your publication since it started. Healthcare IT is such a community, and while my former colleagues and I from other companies run into each other all the time, it is nice to read about folks and see what is happening across the industry. HIStalk is one of the most important things that bind us all together. It has been a joy to read, and I look forward to it every day.

Morning Headlines 7/21/21

July 20, 2021 Headlines No Comments

WebMD Acquires The Wellness Network, Expanding Point-of-Care Services to Health Systems and Hospitals

WebMD acquires The Wellness Network, which offers advertising-supported patient education videos and broadcast channels for hospitals.

Massachusetts eHealth Collaborative Fulfills Mission; Completes Final Dissolution

The Massachusetts EHealth Collaborative dissolves and distributes its assets to six public charities, saying that it has completed its work and fulfilled its mission related to interoperability, standards development, and health IT policy.

Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments

An EHR trigger analysis of the VA’s corporate data warehouse finds that nearly one-third of patients who were admitted for stroke had been discharged from the ED with seemingly benign headache or dizziness in the previous 30 days.

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Reader Comments

  • Ernie Riddle: Good insight and a note that there is a lot of change ahead. Many technology platforms are active in Healthcare and the...
  • Quynh Tran: Appreciate the shift in language from "follow the science" to "evidenced-based." The latter may be less intimidating a...
  • Matthew Holt: I'm at HLTH The testing on site was smooth--once you go into it. The Clear app to get into the testing was not.... ...
  • Steve Ex Twitter: Love it when someone relatively new to the industry has all the answers and calls out the ‘crooks in the room’ who d...
  • Brian Too: We both left out the Chemtrails. D'oh! Time to turn in my X-Files ID. It was tagging me with alpha tracer radiation...

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