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Curbside Consult with Dr. Jayne 1/15/24

January 15, 2024 Dr. Jayne 4 Comments

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I’ve been practicing in the telehealth space since before the pandemic. We deal with a lot of situations that other physicians don’t want to deal with – patients calling for antibiotics, patients with questions about lab results they received through their patient portal after most physician offices are closed, and requests for refills on chronic medications for patients who haven’t been seen by their physicians in a long time period.

Most of the primary care physicians I talk to are grateful that we are out there as a buffer, allowing their patients to receive care without having to be on call 24×7 themselves. However, this week I discovered that apparently a subset of physicians thinks that those of us who practice telehealth exclusively are less than “real” physicians. A newly formed physician education program refused to let me join because I didn’t have an ID badge that has a hospital-style “PHYSICIAN” designation on it. In fact, I don’t have an ID badge at all, which was also an issue.

I submitted a copy of a different photo ID along with a copy of my state medical license, thinking that would suffice. Instead, they asked me for my National Provider Identifier number, which was particularly silly since that can be found via a web search. Once I provided that, they wanted copies of my medical school diploma and residency completion certificate. I’m not sure why a state license wasn’t sufficient, and I hope they had fun trying to read the Latin on my diploma. I had to go digging for those documents since I’m not one of those folks that has them hanging on my office wall. Next time I’ll just use the magic of computers to make a simulated ID badge and be on my way.

The entire experience was annoying, though, and impacts not only telehealth physicians, but any physician who isn’t working in a clinical setting. One doesn’t stop being a physician because they’re not seeing patients. I am definitely going to address this once I am established in the program.

Speaking of annoyances, I had to deal with some annoyances from CMS this week. I received an email from the CMS Identity Management System telling me that my account was going to be deleted due to inactivity. I attempted to log on but couldn’t, and the password recovery system presented a security question that I swear I’ve never seen in my life, because I would have said it was ridiculous if I had. It asked me to provide a telephone number for a relative that was not my own number. I tried to guess when it was that I had set up the account and tried some numbers, which of course were not correct, and the account was locked. The system unhelpfully told me that I needed to call the help desk associated with the application I was trying to access, which was also silly because I have access to multiple applications through the CMS Enterprise Portal. Each of them has their own help desk.

Of course, I was trying to do this at 10 p.m., so I waited until the next business day when I had a gap in my schedule and started calling help desks. The first one was closed because their office hours are only until 4 p.m., and the second one allowed me to hold for 11 minutes and then disconnected me. I called right back and went directly to an agent, so I can only assume their phone system was having a momentary malfunction. The agent clearly had no idea how to help me and was reading from a help desk manual and couldn’t even pronounce some of the application names. He provided another phone number to call. That agent asked me for a bunch of personal data. I finally interrupted and asked whether she’d like to know why I was calling. She seemed surprised that I would want to tell her that. I told her my story, and she said, “Oh, so you just need a password reset?” Bingo! She switched gears and did the reset, giving me a 15-character complex password that I had to write down.

Fortunately, she stayed on the line while I did the reset. The process requires two-factor authentication. I chuckled when I got to the screen that recommended Google Authenticator because it’s supported for “iPhone, Android Phone, and Blackberry.” I wonder how many Blackberry devices they get accessing their system these days. Finally, I was able to set a new password and was on my way. The agent disconnected and I went to set a new security question, since I still had no idea what the answer was for the one with a relative’s phone number.

The list of security questions had some interesting choices. Not only were they strange, but they’re also things that change over time for many people, which doesn’t make them a good security question. The highlight reel:

  • What did you earn your first medal or award for? Hmmm, was it swim team or horseback riding in elementary school? I have no idea.
  • What is your favorite movie quote? I’m at a point in my life where I can barely remember the things I’m supposed to remember, let alone the specific grammar and syntax of a movie quote.
  • What music album or song did you first purchase? I seriously have no clue since it was more than 40 years ago.
  • What was the first computer game you played? Truly have no idea here either, although I was tempted to put Oregon Trail due to the lack of good questions.
  • What was your grandmother’s favorite dessert? I can’t wait until I’m old enough to have a grandchild call and ask me this.
  • Where were you on New Year’s Eve in the year 2000? I think the better question for healthcare workers was where we were on New Year’s Eve in 1999, since many of us were in Y2K hell.
  • Who is your favorite book/movie character? I read more than 50 books a year, so I wasn’t touching this one.
  • Who is your favorite speaker/orator? I can’t remember the last time I saw the word “orator” and was tempted to put Abraham Lincoln, but I knew I wouldn’t remember that down the line either.
  • What is your favorite security question?

I couldn’t believe it when I got to that last one. Again, how would I ever remember the syntax if I selected that one? Maybe “what is the answer to your favorite security question” would have been a better option, since it wouldn’t involve more than a word or two. Still, the entire experience was bizarre and fortunately I was quick enough to grab a screenshot of the list of crazy questions. I sent it to one of my favorite online security experts who replied with four different kinds of eye-roll emojis and GIFs. You can’t make this up, folks. Thanks to CMS for keeping it real.

What’s the weirdest security question you’ve seen? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews G. Cameron Deemer, CEO, DrFirst

January 15, 2024 Interviews No Comments

G. Cameron “Cam” Deemer is CEO of DrFirst of Rockville, MD.

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Tell me about yourself and the company.

I was a latecomer to healthcare IT. I started my career in the ministry and didn’t get into this side of the industry until the early 1990s. I started working with PCS Health Systems in Scottsdale, Arizona. I did about a decade with PBMs, worked with NDC Health for a couple of years building what became Surescripts later, and then joined DrFirst in 2004.

When I joined DrFirst, I would have called it an e -prescribing company, which would have been easy to understand. But since then, we’ve developed a much broader vision. Today, the company is about making sure that patients have their best outcomes through their medication therapy. We do that through offering technology platforms that help providers work with patients around things like electronic prescribing, medication reconciliation, and population health. Our fastest-growing platform addresses patient adherence to therapy.

How has the original vision of e-prescribing expanded?

I had a front-row seat in the early days of e -prescribing. We did some seminal piloting of e -prescribing when I was with PCS. It has gone from essentially a record of what would have been written on a piece of paper to being a more fully informed decision support system.

As an example, we connect to all of the state PDMPs, the controlled substance registries, so that a doctor can consider that information at the same time they are writing the script. They have a much better idea of whether someone is drug seeking or legitimately coming onto therapy. Similarly, a real -time benefit check allows them to understand exactly how much the patient is going to pay. Then, bringing other information in from outside, such as formulary status and electronic prior authorization. Essentially e -prescribing has become an ecosystem as opposed to just a replacement for the prescription pad like it was originally started.

How does seeing cost and insurance coverage at the time of prescribing improve patient outcomes as well as patient satisfaction?

We view it as two parts. There’s what happens in the doctor’s office when they are  prescribing therapy, and then what happens after the patient is released back into the wild to act on the prescription.

In the physician’s office, we think that real -time benefit improves compliance with therapy, because it finally gives the physician a real idea about the impact of what they are prescribing. How much is this drug going to cost versus that drug? Or is therapy going to be delayed because you have to go through a prior authorization if you choose this therapy versus that therapy? It is giving the physician real insight. They already know what they want to write, so now they get insight into what the outcome will be from the patient’s perspective.

The reason that we started working downstream from there, on what happens to the patient after they walk out of the office, is that we often found that the providers maybe didn’t have time, or maybe they weren’t focused enough on the extra information, and weren’t necessarily helping the patient make a decision that would be ideal for the patient to then go fulfill the therapy. 

We try to hit the patient immediately after they leave the doctor’s office with more information. What prescriptions were written? Where are they going to get them filled? We have a call to action to pick up the prescriptions. We provide financial assistance information if the physician has chosen a drug that is extraordinarily expensive for the patient. We give the patient the tools to make up for what may have been missed when they were in the provider office, or to reinforce the decision the provider made.

Have coupon-type programs, such as manufacturer assistance programs or GoodRx, made displaying patient prices more complicated?

Systems have come a long way in being able to present all that at once. From a provider perspective, they wouldn’t be perceived as a set of different decisions. At least for our system, it’s all combined into one decision point, so the physician can consider them all at once. From a patient perspective, it would only really be one thing, because their therapy has already been decided at that point. Now they just have the one decision to either pick it up or don’t pick it up. The financial incentives can help them with the “pick it up” decision if they are available.

Has the prior authorization process, which everyone seems to agree is burdensome, improved?

Boy, I agree that it needs to be fixed, so I’m on that page. Prior authorization is widely recognized as a coping mechanism, a way to stem the flow of products that the payers feel are expensive. They don’t necessarily want to cover the therapy unless they are pushed to do so.

I’m not sure how much incentive exists to truly fix it. Truly fixing would look like the barriers make sense and they are readily overcome. What’s going on in the industry right now to fix it is that when the physician is confronted with a screen they have to fill out for the prior authorization, can we just grab that information out of the EHR, fill in the form, and let the physician have very little work to do to send that PA?

The whole thing is counterintuitive. They are intended as a barrier. Making it easy makes the barrier less effective. It’s an interesting problem that I’m not sure we are really solving yet.

If the prior authorization is a prescribing speed bump that payers hope will discourage the prescription, what interest would payers have in solving the problem? Why couldn’t they look at a prescriber’s history, even with AI if needed, and bypass the front-end work unless that provider is an outlier in deviating from accepted norms?

That would be a fascinating way to handle it. I’ve actually not thought about that before, but with machine learning and AI, you should be able to analyze, give the doctors some kind of performance score, and put a lower set of barriers in front of those who are good actors. There would be a lot of discussion about what equals a good actor from a provider perspective. I imagine there’s a wide range of thought on that.

An interesting development is Lilly’s program, where they are to some degree working around these kinds of restrictions with some of their new drugs for weight control and diabetes management. They appear to be sidestepping the process and maintaining pricing control rather than throwing rebates at formulary status. 

Rather than being told that your drug will go off formulary unless you can bring this price way down from a PBM perspective and that you will be faced with a prior authorization hurdle that will be a giant pain to get people on, they are essentially setting up a parallel system. Patients can have relatively simple access to the drug and they can help manage the cost for the patient without causing the kind of disruption to everybody that a massive rebate program causes. Good or bad, I think it’s a really interesting approach that was creative on Lilly’s part.

It’s also interesting that they are working with third-party companies for telehealth prescriptions and pharmacy fulfillment. Will other drug companies follow suit?

I want to reinforce that what they have effectively done with those third parties is sidestepped the plan design. Patients are being asked to go outside of the health plan that they are paying for, and instead participate in this other parallel program that’s been set up for these drugs.

That will make it a little more difficult for other drugs. Not many drugs have the demand profile of the weight loss drugs. If your expensive drug is less in demand, there’s probably less incentive for the patient to step out of their plan design. I’m paying for this insurance, I should use it, that kind of psychology, so I wouldn’t think that everybody will be in a position to follow suit. But it’s a creative model when the drugs fit the profile that would make this work. It’s brand new, so we don’t know yet.

Lilly is also potentially keeping some of the revenue that would have otherwise gone to PBMs or pharmacies while gaining control over pricing. Is there a DrFirst technology implication for manufacturers that sell drugs directly with patient discounts?

One of the things we are excited about is our ability to engage patients, let’s say five minutes after they leave the doctor’s office. Because of our position in workflow on the prescriber side, we actually know when the electronic prescription has been sent. At that point, we can reach out and engage a patient. We are four and a half million patients a week touching about one out of every four new prescriptions. Our scale has  gotten fairly large because of the number of EHRs that we work with.

As a result of that, we are in a position to work with somebody like Lilly to be an entry point for patients into their program who might not know about their program. In the event that the physician bypasses whatever opportunities Lilly has provided for them, we have an opportunity to talk to both the provider and the patient because we sit squarely in that workflow. So yes, I hope we can be a part of that. I really enjoy these creative solutions to persistent problems around cost in healthcare.

What is the state of medication history and its delivery directly into the clinician’s EHR workflow?

I would say not greatly improved. There may be broader access to records now, a more complete patient record. But not much has happened to clean up the dirtiness of the data, this kind of shady underbelly of the whole data space. We spend a lot of time on data optimization because we find that the data feeds still are not semantically usable by the people who receive them.

As an example, somebody who creates a record might be using Latin abbreviations, and somebody who is receiving it might use English abbreviations. No matter what abbreviations they use, they can still write the sigs [abbreviations for instructions] differently and you can make millions of different combinations out of any given sig, depending on how the one system prepared it and how the other system wants to receive it. A big part of our business remains matching those data feeds up. How do you massage the incoming feed to make sure that all the fields are discrete and all the data elements are ready to be imported into the receiving system so that somebody doesn’t have to manually retype it?

That kind of data optimization is still missing from the industry and still needs to be handled independently before a system can receive the records. The bottom line is that I would say that there’s availability of a lot of records now, more than there’s ever been, but they are still just as dirty as they were years ago and still need that cleanup.

What role do you see for AI in your business and the industry in general?

We’ve been all over AI for data optimization for at least six years now, and it makes a huge difference. Machine learning and AI provides a much more elegant and complete solution than, say, a table of substitutions. You can only anticipate so many errors that a person might make, and the ability of the AI to sort that out automatically is huge. We end up with much higher rates of cleanliness of the data than are available through traditional methods.

We call that augmented intelligence, meaning that we do the cleanup, but then we provide the clinician with both the original and the cleaned up version. If they’re good with it, they can just say, “That’s good.” Otherwise, they can tweak it if it’s incorrect in some way. We put most of our focus on trying to find practical problems in the workflow and provide an efficient solution so that providers can get more work done and get away from that burned out feeling of having to retype everything.

What are the company’s near-term priorities?

One of our major business lines is providing e-prescribing platforms for EHRs. We serve over 300 EHRs in that way. A major change is coming in 2027, when Surescripts is going to implement the 2023 version of the SCRIPT standard. We expect other changes to come along with that. That will make everybody stop and do major development in their systems again. A big part of what we’re going to do over the next few years is work on helping people with that conversion. Some will decide that this is the last straw and that it’s not worth maintaining their own e-prescribing channel any more and we’ll be able to do integrations with additional companies. It will be a major focus to make sure that the industry is ready for this big change in coming in 2027 around prescribing standards.

Another major focus for the company is to continue to drive our adherence programs. We believe that we will eventually get to one out of every two new scripts, and when we have that level of aggregation, we will be meaningfully able to address things like access to specialty scripts. The industry is moving towards specialty drugs at this point, and those have all kinds of access challenges. We’re going to be spending a lot of time cleaning up those processes for the industry and making sure that patients can get on therapy quicker and stay on therapy for specialty.

The last thing is perhaps a little controversial, but we believe that it’s time to take a hard look at what happens after a script leaves the doctor’s office before it gets to the pharmacy. We’ve been working since the 2000s under a 50-year-old technology, the switching network that we use to move scripts between doctors and pharmacists. It’s a lowest common denominator solution that lets everybody have a level playing field, but doesn’t give anybody an opportunity to innovate and try new models.

We’re going to be breaking out of that mold over the next few years. We are standing up a capability to provide real innovation in this space with a broader set of data exchange between providers and pharmacies to enable better business flows on both sides of the equation. Just think about when you write a script, knowing that the drug is in stock at the pharmacy you are writing it to. Or if you’re on the pharmacy side trying to do some primary care type functions, think about what it would mean to get a patient record at the same time the script comes to you. That kind of innovation isn’t available today. We’re going to make that a part of how the industry works going forward.

I got into this industry in 1992 and have been talking to pharmacists this whole time. They are always trying to find that a breakthrough to be able to work at the top of their license, but never getting there. We’re developing our pharmacy channel to get closer to pharmacy. That takes a while. It’s a big area, and you need to build some trust. But I’m hoping that we can finally help them practically get there where they’ve really struggled before. Since we have theses massive EHRs behind us on one side and pharmacy customers on the other side, we believe that we can finally bring them together so that we get this real collaboration around the patient that has eluded the industry for a long time.

Morning Headlines 1/15/24

January 14, 2024 Headlines No Comments

Towards Conversational Diagnostic AI

A Google-created AI system called AMIE that was optimized for diagnostic dialog outperforms primary care doctors in synchronous text chat with patient actors.

Broadwest’s luxury hotel to host Oracle’s larger-than-anticipated health care summit

Oracle pushes its Health Summit back from February to April and moves it to Nashville, where it will also build a new campus using $175 million in economic incentives.

Law firm that handles data breaches was hit by data breach

A law firm that specializes in business security incidents is itself hit by hackers, exposing the identity, medical, and insurance information of 637,000 people that it had collected from its security incident clients.

Monday Morning Update 1/15/24

January 14, 2024 News 4 Comments

Top News

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A Google-created AI system called AMIE that was optimized for diagnostic dialog outperforms primary care doctors in synchronous text chat with patient actors. The authors warn that while this isn’t representative of clinical practice and thus places clinicians at a disadvantage to AI, the accomplishment is still a milestone in developing conversational diagnostic AI.

The evaluation criteria included history-taking performance, diagnostic accuracy, management reasoning, communication skills, and empathy.

The authors observe that history-taking and diagnostic dialog is dependent on context and requires a high level of clinician skill.

The tool was trained on medical licensing exam questions, real-life medical summaries, and audio transcripts from 100,000 medical conversations. It was further trained and refined by using self-play, where AI improves its performance by playing against itself and analyzing which of its approaches were successful.


Reader Comments

From A Beautiful Mind: “Re: Amazon. Your post about Health Conditions got me thinking about previous Amazon healthcare forays such as HealthLake, One Medical, etc. Do you speculate that they are throwing a lot of darts to see which ones stick, or is there a John Nash-like team in Seattle piecing together the chaos for ultimate world domination, and oh yeah, improving care and lowering costs?” Amazon is smarter than I, but I don’t understand its healthcare plan. The company doesn’t always hit healthcare home runs (see: Amazon Care, Haven, and Halo) but it swings a mighty bat and learns from failure. It hasn’t done much with online pharmacy PillPack, and buzz about its “all the pills you take for $5 per month” RxPass died down pretty quickly after it was announced a year ago. It paid $4 billion for money-losing primary care concierge practice One Medical, with few changes except to offer Prime members a discount on joining One Medical, which still bills insurance traditionally and is now is exposed to Amazon-recruited members who are older and less affluent that One Medical’s former client base. Amazon’s recent offerings seem to focus on charging to advertise third-party healthcare businesses. Healthcare is a financially appealing vertical, but is notoriously hard for even big-name outsiders to penetrate due to billing complexity; a hellish regulatory environment; the local and trusted presence of big health systems and national drug chains where Amazon is to many just a website or app that often sells offshore-sourced junk using phony reviews, and the challenge of scaling without killing someone. I think of Amazon as a company that makes money from selling ads, fulfillment services, and AWS with zero personal touch, which doesn’t suggest a broadly disruptive role in healthcare.

From Y2K11 Maverick: “Re: HIStalk. I last said this 10 years ago, but it has remained true. Rarely does a week go by that 1) I don’t learn something new by reading HISTalk updates and/or 2) I pass along something from your posts that my colleagues hadn’t seen before. THANK YOU for all that you’ve done, do and (hopefully) continue to do for us schmoes who are just trying to keep up! Loyal listener since 2011!” Thanks.

From JD: “Re: Billy Idol at ViVE. Your mention reminded me of John Lydon, aka Johnny Rotten of the Sex Pistols, who was his wife’s caregiver.” The 67-year-old punker was a full-time caregiver of Nora Foster, his wife of 44 years, for nearly 15 years until she died of Alzheimer’s in April 2023 at 80 years old. He said in an interview just before she died, “We know that she’s going to slowly deteriorate into something catastrophic, and then death. But she will enjoy every step of it, and I’m here to make sure of that because she’d do the same for me.”

From JustScratchingMyHead: “Re: the Texas surgeon sharing gender-affirming care records.  While technically he did redact the information, it still seems procedurally not correct and I would think the hospital would have some type of policy about screenshots being taken and sent externally. What happens when the next provider sends the information without proper redaction or none at all?” Ethan Haim, MD graduated from his Baylor surgical residency the day that HHS knocked on his door. He was an anonymous whistleblower until June 2023  and has moved on to Hunt Regional Healthcare as a general surgeon. The hospital’s bigger beef with him beyond screenshots would have been his efforts to get them in trouble with the state. He likens transgender interventions for children to COVID, arguing that both involve scant peer-reviewed medical evidence and the institutional censorship of those who question it.


HIStalk Announcements and Requests

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Provider poll respondents aren’t confident that their employer-paid conference attendance generates ROI. However, commenters add that attendance has value beyond immediate ROI, such as gaining knowledge, networking, and recruiting.

New poll to your right or here, for provider employees: which is your preferred medium to learn what a vendor does? This is in response to user comments. I’ll admit that while I’m critical of TL;DR types who can’t read more than two consecutive sentences without blaming the author with indignation rather than embarrassment for their phone-stunted attention span, I’m similar with videos, however – people who host them and love themselves excessively sometimes can’t shut up and let their guests speak. I f a video can’t tell me something useful in the first 30 seconds (or a text article in three sentences), the situation isn’t likely to improve and I move on.

Your to-dos for supporting what I do:

  • Join my spam-free mailing list.
  • Connect on LinkedIn and join Dann’s HIStalk Fan Club so that I see your posts and job changes.
  • Tell my sponsors, or potential ones, that you value their support.
  • Share news, rumors, and intriguing insights.

Webinars

January 19 (Friday) 1 ET. “Unlocking Reliable Clinical Data: Real-World Success Stories.” Sponsor: DrFirst. Presenters: Alistair Erskine, MD, MBA, CIO/CDO, Emory Healthcare; Jason Hill, MD, MMM, associate CMIO, Ochsner Health; Colin Banas, MD, MHA, chief medical officer, DrFirst. Health system leaders will describe how they are empowering clinicians with reliable patient data while minimizing workflow friction within Epic. They will offer real-world experience and tips on how to deliver the best possible medication history data to clinicians at the point of care, use clinical-grade AI to infer and normalize prescription instructions in Epic, and encourage patient adherence to medication therapies for optimal outcomes.

January 24 (Wednesday) noon ET. “Medication Management Redefined.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Caleb Dunn, PharmD, MS, senior product manager, DrFirst. Clinical workflow experts will paint a reimagined vision for e-prescribing that offers enhanced patient adherence, customizable clinical support, intelligent pharmacy logic, and data integrity and safety. Join this first chapter of an ongoing conversation about what medication management should be, how to deliver greater benefits today, and how to prepare for the future. Elevating your solution and customer benefits isn’t as hard, scary, or economically challenging as you may think.

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


Sales

  • Outpatient rehab provider Ability KC choses Netsmart’s TheraOffice EHR/PM.

Announcements and Implementations

Oracle moves its Health Summit to Nashville and pushes it back from February to April. Tennessee offered Oracle $175 million in incentives to build a $1.4 billion campus in Nashville that will likely have a significant Oracle Health presence. The company’s Oracle Health Conference, the former Cerner Health Conference, was held in Las Vegas in September 2023.


Government and Politics

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The chairs of the Kansas senate commerce and house judiciary committees ask Governor Laura Kelly to explain why the Department for Children and Families awarded $7.7 million of a $18 million federal social services grant to software vendor Unite Us. They question why so much of the money will be sent to an out-of-state company instead of being used to support local social service programs.

A Bloomberg article on the effects of significant national relocation on elections highlights Epic, whose large headcount and 3,000 hires in 2023 are mostly young and college educated.

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A Senate subcommittee reviews finds that national drugstore chains don’t require a warrant to provide law enforcement with the patient records they request for whatever reason, with Sen. Ron Wyden (D-OR) calling for HHS to update HIPAA to require pharmacies to insist on a warrant before disclosure in response to regulatory and law enforcement records requests.


Privacy and Security

A law firm that specializes in business security incidents is itself hit by hackers, exposing the identity, medical, and insurance information of 637,000 people that it had collected from its security incident clients.


Other

Former Olympic gymnast Mary Lou Retton was uninsured for her month-long hospital stay for pneumonia, for which she blamed pre-existing conditions and lack of affordable premiums. Either she’s not telling the whole story or she is unaware of Affordable Care Act plans that are legally required to cover pre-existing conditions and extend premium subsidies based on income. The 55-year-old Retton says she has since obtained insurance, but didn’t say if she paid for it from the $460,000 her four daughters raised for her via social media. She declines to name the hospital.


Sponsor Updates

  • Meditech reports record international growth for its Expanse EHR in 2023.
  • Nym will exhibit at the HFMA Western Region Symposium January 21-24 in Las Vegas.
  • Optimum Healthcare IT announces that it has been named a Workday Staffing Partner.
  • Verato publishes a new e-book, “How to overcome HHS identity management challenges.”

Blog Posts


Contacts

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

Morning Headlines 1/12/24

January 11, 2024 Headlines, News No Comments

Artisight to Scale and Advance AI-driven Smart Hospital Platform with Oversubscribed $42 Million Series B Round

Artisight, which offers a smart hospital platform, raises $42 million in a Series B funding round.

New Veradigm Leadership Provides Outlook on Business and Strategy, and Refreshed Financial Estimates for Fiscal 2023

Veradigm lowers its FY2023 revenue and earnings guidance below consensus estimates, noting in an SEC filing that it doesn’t yet know when it will file overdue financial reports for the last three quarters and year-end of FY2023 or convene its annual meeting of shareholders.

Hewlett Packard Enterprise to buy Juniper Networks in $14 bln deal

Hewlett-Packard Enterprise will acquire AI-enabled enterprise networking and security technology company Juniper Networks for $14 billion.

Graphium Health Acquires The ABG Anesthesia Data Group Strengthening Anesthesia Quality and Safety Initiatives

Anesthesia healthcare technology vendor Graphium Health purchases The ABG Anesthesia Data Group, which specializes in qualified clinical data registries management.

News 1/12/24

January 11, 2024 News 3 Comments

Top News

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Artisight, which offers a smart hospital platform, raises $42 million in a Series B funding round.

Co-founder and CEO Andrew Gostine, MD, MBA formed the company while working in his anesthesiology residency.


Reader Comments

From Video Kills Brain Cells: “Re: vendor videos. I saw Dr. Jayne’s mention that she doesn’t watch them. You should conduct a poll.” I’m with Dr. Jayne in usually declining to spend time consuming vendor videos or podcasts. Skimming text visually is faster than watching even 3x speed video unless the graphics are uncharacteristically vital. My advice to those who create multimedia is to avoid making it an either-or situation – send your video or audio files to an AI-powered transcription service like I use, and for an incremental cost and time of just about zero, you can post the transcript along with the original and satisfy both audiences. Requiring people to sit through your precious AV meanderings is a vanity play that excludes some folks who might be interested. Perhaps my poll will ask whether respondents are decision-makers since I don’t picture many C-suite members using video as their preferred vehicle for gaining industry information.

From Letme Throw: “Re: AI. I”m curious to hear your thoughts about the 2024 strategies that were announced by Oracle Health and Epic.” Oracle’s Larry Ellison talked up AI and voice-powered user interfaces in announcing the Cerner acquisition in December 2021, saying that Oracle would jump-start the business converting to a primarily voice-based UI for Millennium using Oracle’s Digital Assistant (along with creating a national EHR database, rewriting Millennium, getting the VA’s implementation done, etc.) I haven’t seen examples of Oracle Health’s real-life use of AI, not to mention that it won’t really matter if they keep losing customers to Epic. Epic seems to be way ahead, with some of its clients testing or using ambient listening documentation, inbox management, scheduling automation, AI-enhanced Cosmos research inquiries, and enhanced patient communications. Epic’s user base of huge academic health systems also gives it access to on-the-ground innovators who have the resources to design, use, and even develop AI-related tools that have an actual use case that is free of Oracle’s vested interest as a tech company in selling technical products to Cerner users. I would have low expectations of the provider impact of a quick bolt-on of Digital Assistant. I would enjoy hearing directly from Cerner and Epic customers about how they are using, or hoping to use, AI with their respective products. Also note that Meditech has arguably done a lot more with AI in Expanse than Oracle Health in Millennium, and at a friendlier price point.


HIStalk Announcements and Requests

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Something reminded me of one-time high flyer Nant Health, which hit $21 per share on its first day of trading in mid-2016 drug billionaire Patrick Soon-Shiong, MD launched several Nant-named companies. Those shares are now at $0.06, valuing the company at $12 million. The company’s headquarters address is a UPS store in the tiny town of Winterville, NC, a few steps away from the notable Sam Jones BBQ.


Webinars

January 19 (Friday) 1 ET. “Unlocking Reliable Clinical Data: Real-World Success Stories.” Sponsor: DrFirst. Presenters: Alistair Erskine, MD, MBA, CIO/CDO, Emory Healthcare; Jason Hill, MD, MMM, associate CMIO, Ochsner Health; Colin Banas, MD, MHA, chief medical officer, DrFirst. Health system leaders will describe how they are empowering clinicians with reliable patient data while minimizing workflow friction within Epic. They will offer real-world experience and tips on how to deliver the best possible medication history data to clinicians at the point of care, use clinical-grade AI to infer and normalize prescription instructions in Epic, and encourage patient adherence to medication therapies for optimal outcomes.

January 24 (Wednesday) noon ET. “Medication Management Redefined.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Caleb Dunn, PharmD, MS, senior product manager, DrFirst. Clinical workflow experts will paint a reimagined vision for e-prescribing that offers enhanced patient adherence, customizable clinical support, intelligent pharmacy logic, and data integrity and safety. Join this first chapter of an ongoing conversation about what medication management should be, how to deliver greater benefits today, and how to prepare for the future. Elevating your solution and customer benefits isn’t as hard, scary, or economically challenging as you may think.

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


Acquisitions, Funding, Business, and Stock

Veradigm lowers its FY2023 revenue and earnings guidance below consensus estimates. MDRX shares have lost 47% of their value in the past 12 months, much of that in a big price drop in early December. The company said in an SEC filing Wednesday that it doesn’t yet know when it will file overdue financial reports for the last three quarters and year-end of FY2023 or convene its annual meeting of shareholders.

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Rune Labs, whose FDA-cleared software tracks symptoms of Parkinson’s disease via the Apple Watch, raises a $12 million funding round. CEO Brian Pepin, MSEE founded the company after leaving his senior hardware engineer job at Verily Life Sciences in late 2018.

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An Apple share price drop caused by demand doubts makes Microsoft the world’s most valuable company. Had you invested $10,000 in MSFT shares 10 years ago, you would have nearly $102,000 today, or if you are former CEO Steve Ballmer, you would be rolling in $128 billion worth of shares that throw off $1 billion per year in dividends.


Sales

  • Spectrum Healthcare (AZ) chooses NextGen Healthcare for EHR/PM.

People

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Industry long-timer Jeff Stern (Carium) joins Brado as VP of business development.


Announcements and Implementations

AI medical scribing technology vendor DeepScribe launches integration with Epic’s SmartData elements, allowing users to customize note preferences and standards that are mirrored in Epic.

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Clearsense will present Billy Idol live in concert at ViVE 2024 in Los Angeles next month. I saw him a few years ago and he puts on a good show that goes beyond sneering through “Rebel Yell.” I’m predictably skeptical about the relevance of celebrity entertainment to healthcare, but if you are spending your employer’s money to attend ViVE, you might as well happily pump your fist overhead along with the punk rocker, who has been Medicare-aged for several years.

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Amazon rolls out its Just Walk Out checkout-free technology to hospitals, allowing employees to pay for food by scanning their badges to create a payroll deduction.

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PerfectServe’s Lightning Bolt describes combinatorial optimization, a mathematical process that chooses the best possible solution given a finite set of possibilities. The interesting article describes, with some level of detail, how the company uses that process, rather than the more common heuristic method, to build the best physician schedules. The article wasn’t credited, but someone did a nice job of explaining a useful concept.

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Caregility announces its new telehealth edge devices for hospital-based telehealth such as e-sitting, virtual rounding, patient-family communication, and tele-ICU, with OhioHealth and UMass Memorial Health being early adopters.

Palantir and University of Colorado Anschutz Medical Campus establish the Center for Linkage and Acquisition of Data as part of the NIH’s All of Us research program. The project will integrate claims and mortality data and address the challenges of linking EHR data from health information networks to improve data completeness. The principal investigator of the 18-month, renewable project – which is funded by a $30 million NIH grant —  is Melissa Haendel, PhD, the chief research informatics officer of the medical campus.

Health insurer Elevance will offer people who are covered by its Medicaid health plans a free smartphone with unlimited data, talk, and texting to provide access to digital and virtual healthcare tools, supported by funding through the FCC’s Affordable Connectivity Program.


Privacy and Security

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HHS investigates a 33-year-old Texas surgeon for providing case lists of minors who were undergoing gender-affirming care at Texas Children’s Hospital to a conservative activist, which HHS deems to be a HIPAA violation. Eithan Haim, MD, who completed his residency in 2023, says that he is innocent because he redacted specific information from his Epic screen shots. The hospital said in March 2022 that it was halting provision of the services in response to the state’s interpretation that they constitute child abuse, but his records indicate that treatments continued. I’m thinking that at least from the redacted screenshot provided, he’s correct in that while he disclosed some of the 18 HIPAA identifiers (such as age and diagnosis), redacting patient-identifiable fields such as name or medical record number makes it de-identified PHI, which isn’t protected by HIPAA, although the question remains about whether he accessed and disclosed the data inappropriately if not illegally. I suppose HHS knows best.

Novant Health will pay $6.6 million to settle a lawsuit that was brought by 10 of its patients for the health system’s use of the Meta Pixel website user tracking tool.


Other

Two hospital EDs in Australia will revert to their previous IT system for six months after implementation of InterSystems TrakCare in mid-November caused long patient wait times and user frustration.

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Noetik co-founder and CEO Ron Alfa, MD, PhD shares his tab for a single bottle of water at the J.P. Morgan Health Care Conference in San Francisco, where the moneylenders fly private to sit at $100 per hour lobby tables while pondering the mystery of why US healthcare is so expensive.


Sponsor Updates

  • EClinicalWorks announces that McKenzie Health System (MI) is improving operations using its EHR, clinical rules engine, and robotic process automation.
  • Net Health launches the next phase of its digital musculoskeletal thought leadership program in partnership with the American Physical Therapy Association.
  • First Databank names Kara Zebrowski (Glytec) product manager, Hamman Eltareb (Hearst Health) health data analyst, and Christian Wong software engineer.
  • Findhelp launches season two of its American Compassion Podcast about the history of the social safety net in America.
  • Meditech recognizes international customers of its Expanse EHR, which include providers in East Africa, Ireland, Australia, UK, and Singapore.
  • FinThrive releases a new episode of its Healthy Rethink Podcast, “He’s Here, He’s There … Virtual Care Everywhere.”
  • Medicomp Systems releases a new episode of the Tell Me Where It Hurts Podcast featuring Juan Carlos Gallegos, RN senior director of product, Homecare Homebase.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 1/11/24

January 11, 2024 Dr. Jayne 2 Comments

Masks are back on at my local hospitals. Our area is seeing a surge of COVID, influenza, and RSV patients. We’re seeing full intensive care units. Nursing exhaustion is approaching pandemic levels.

Across the US, hospitals are experiencing staffing challenges, which often cause beds to be unavailable because they aren’t staffed. This rolls downhill in the hospital, landing in the emergency department that has to board the patients until beds are available. In turn, this can back up ambulances, which leads to delays in 911 calls. For my friends working in EMS, this is starting to feel a lot like 2020, and in my community, the COVID-related hit to EMS staffing is still present.

If you’re on the healthcare IT side and the clinical staffers that you are interacting with seem frazzled and distracted, it’s because they are. One of my ICU nurse colleagues commented, “It’s like people forgot what we went through and just don’t care about healthcare workers any more.” Let’s remember to wash our hands, stay home when you’re sick (or wear a well-fitting mask if you can’t stay home), and look after each other. We’re all in this together.

I’ve started working on a project that involves an area of clinical informatics that I haven’t worked on in some time. To get up to speed with the vendor landscape, I’ve been visiting lots of websites to view white papers and customer case stories. Maybe my brain is just used to operating in an older way of working, but I find myself increasingly annoyed when companies have decided that the only way they’re going to share information on their websites is through videos. Some of us absorb more through reading actual words. Of course, others are more visual or auditory learners and might do better with that kind of content.

For me, it’s often a time issue. I can read much faster than most video presenters speak, which means that when there is only video content available, I tend to perceive the sites as not being a good use of my time. It left me wondering what happened to the good old written word and whether it’s just me or whether times have changed and I need to get used to my work taking 50% longer than planned.

A primary care colleague reached out to me today, venting that her organization has yet to configure the EHR to allow physicians to submit the G2211 billing code that went into effect on January 1. That’s an add-on code that allows physicians to submit charges for the time they spend building longitudinal relationships with patients and addressing patients’ issues over the long term. CMS describes the code as billable for “visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed healthcare services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition.”

The nature of the relationship between the patient and the physician is the factor that determines whether the code should be used. It’s worth around $16 when billed for Medicare patients, so it’s not designed to drive significant revenue, but rather to offset some of the valuable whole-person care that is provided by primary care physicians. Medicare’s documentation about the change says that the typical primary care physician who has Medicare beneficiaries in their patient panel will coordinate care with 229 physicians in 117 disparate practices. If it hasn’t yet been added to your EHR workflows, your clinicians are missing out.

The US continues to have supply and demand issues with stockpiles of personal protective equipment (PPE). A recent AP report explored the fact that states that had scarcity of supplies during the high points of the COVID pandemic are now dumping PPE at an alarming rate. Ohio has auctioned off nearly 400,000 protective gowns and has thrown away 7 million gowns along with countless masks, gloves, and other supplies. States are having to determine their go-forward strategies for supply stockpiles and preparation for potential disasters.

The amount of materials that is being shredded, recycled, or destroyed is simply staggering. Georges Benjamin, MD, executive director of the American Public Health Association, mentioned that our “bust-and-boom public health system” creates waste as well as lack of preparedness. Many states didn’t respond to the AP’s request for information, so it’s hard to know exactly how large the problem might be.

As a CMIO, I’ve worked on a number of projects around health literacy. I would bet that most people in healthcare IT don’t understand the level of understanding of the average patient. For written communications, we need to focus our writing at roughly the fifth-grade level to ensure that patients will be able to understand any instructions we provide. Organizations have also made significant efforts to provide documents for as many patient-preferred languages as possible.

I was excited to see this article that looked as the association among hospitalizations, emergency department visits, and health literacy interventions. Researchers concluded that patients who read patient education materials and summarize their understanding back to the care team are 32% less likely to be hospitalized and 14% less likely to visit the emergency department. Additionally, there was an association with overall declining health costs in patients who received the intervention. The study was performed using subjects that were part of an employee health plan, so it’s not clear if results are generalizable to all patients. Thanks to Healthwise for including this study in their blog, otherwise I would likely have missed it.

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The Consumer Electronics Show is upon us, and Garmin is finally taking a giant leap forward in the realm of wearables by introducing a women’s heart rate monitor that clips onto a sports bra and doesn’t require a separate strap. For anyone who has had to deal with a heart rate monitor strap interfering with your bra, this is a welcome addition. The HRM-Fit strap retails for $150.

What are the best and worst things you’ve seen coming out of the Consumer Electronics Show? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/11/24

January 10, 2024 Headlines No Comments

Mayo Clinic pairs with Cerebras Systems to help develop AI for health care

The Mayo Clinic will use computing chips and systems from Cerebras to develop its own AI models, such as summarizing a patient’s medical records, analyzing diagnostic images, and reviewing genomic data.

FTC Order Prohibits Data Broker X-Mode Social and Outlogic from Selling Sensitive Location Data

The FTC prohibits data broker X-Mode Social and successor Outlogic from selling or sharing sensitive location data, settling allegations that X-Mode sold data that could be used to track specific people’s visits to medical facilities, places of worship, and domestic abuse shelters.

OpenAI debuts ChatGPT subscription aimed at small teams

Boston Children’s is an early adopter of OpenAI’s new ChatGPT Team tool, using the subscription-based model to pilot GPTs for productivity and collaboration.

Healthcare AI News 1/10/24

January 10, 2024 Healthcare AI News No Comments

News

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OpenAI launches the GPT Store, which allows users to distribute – and eventually charge for – customized GPTs that they have created. The company also announces ChatGPT Team, a $25 per-user per-month secure workspace for teams of up to 149 people that supports GPT sharing. The company lists Boston Children’s Hospital as a early adopter, which says that it has used Team to pilot GPTs for productivity and collaboration.

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OpenAI announces that wearables vendor Whoop has incorporated GPT-4 into its app that offers personalized fitness and health coaching related to heart rate, workouts, sleep, and stress. The Whoop 4.0 device is free for those who sign up for a $239 per year subscription.

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Microsoft changes the layout of its keyboard for the first time in 30 years by adding a Copilot key that invokes the AI assistant.


Business

The Mayo Clinic will use computing chips and systems from Cerebras to develop its own AI models, such as summarizing a patient’s medical records, analyzing diagnostic images, and reviewing genomic data.

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Sword, which offers digital health solutions and services for pain prevention and treatment, says that it delivered 1.5 million AI Care sessions in 2023. Sword says that it developed and patented the world’s first AI care solution in 2018.

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ShifMed launches ShiftAdvisor, an AI-powered solution that optimizes nurse shift scheduling by considering preferred days, times, pay, and locations.

Accenture invests in Israel-based QuantHealth, which uses AI to simulate drug clinical trials in the cloud.

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Innovaccer announces Sara, an AI scribing assistant that transcribes, summarizes, and analyzes visit conversations to create SOAP notes.

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Direct-to-consumer drug marketing technology vendor Swoop enhances its AI drug adherence tool to allow drug companies to market their products to patients and their doctors before a diagnosis has been made. They don’t say how they do that, but its other products create custom market segments using the de-identified data of 300 million people that it gets from Datavant and Epsilon.


Other

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Vanderbilt University Medical Center lists its AI accomplishments in clinical and research settings:

  • Running a 10-physician pilot of Nuance DAX Copilot to create encounter notes from ambient listening.
  • Offering researchers a VUMC-created, GUI-based version of OpenAI’s large language module, which is HIPAA certified under VUMC’s business associate agreement with Microsoft. VUMC has disabled access to the public version of ChatGPT on its networks.
  • Creating the IQueue platform to optimize chemotherapy infusion appointments.
  • Developing a stroke patient evaluation tool that delivers quantified and color-coded CT perfusion maps.
  • Creating its own AI application to predict elective surgical case volume.

Contacts

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

Morning Headlines 1/10/24

January 9, 2024 Headlines No Comments

Harris Acquires Fivos Workflow Solutions, Software Dedicated to Advanced Vascular and Cardiovascular Reporting Workflows

Harris acquires the Medstreaming vascular and cardiovascular reporting, practice management, and billing solution of Fivos, which Harris will offer under its Picis brand.

Vita Health Announces $22.5M Series A Funding Round

Suicide prevention-focused telemedicine company Vita Health raises $22.5 million in a Series A funding round.

After Barrage of Hacks, Hospitals Will Face New Federal Cybersecurity Rules Tied to Funding 

HHS will reportedly propose within the next few weeks cybersecurity rules for hospitals that will tie the establishment and management of digital defenses to federal funding.

News 1/10/24

January 9, 2024 News 1 Comment

Top News

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Amazon adds Health Conditions Programs to its Health services to help Amazon account holders find and enroll in digital health programs that are covered by their insurance plans.

The online retailer has tapped Omada Health, which offers programs for diabetes prevention, and diabetes and hypertension management, as its launch partner.

The Amazon program will apparently advertise third-party digital health products. It will be interesting to see how insurers react to having their customers pitched to buy digital health services at the insurer’s expense.


Webinars

January 19 (Friday) 1 ET. “Unlocking Reliable Clinical Data: Real-World Success Stories.” Sponsor: DrFirst. Presenters: Alistair Erskine, MD, MBA, CIO/CDO, Emory Healthcare; Jason Hill, MD, MMM, associate CMIO, Ochsner Health; Colin Banas, MD, MHA, chief medical officer, DrFirst. Health system leaders will describe how they are empowering clinicians with reliable patient data while minimizing workflow friction within Epic. They will offer real-world experience and tips on how to deliver the best possible medication history data to clinicians at the point of care, use clinical-grade AI to infer and normalize prescription instructions in Epic, and encourage patient adherence to medication therapies for optimal outcomes.

January 24 (Wednesday) noon ET. “Medication Management Redefined.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Caleb Dunn, PharmD, MS, senior product manager, DrFirst. Clinical workflow experts will paint a reimagined vision for e-prescribing that offers enhanced patient adherence, customizable clinical support, intelligent pharmacy logic, and data integrity and safety. Join this first chapter of an ongoing conversation about what medication management should be, how to deliver greater benefits today, and how to prepare for the future. Elevating your solution and customer benefits isn’t as hard, scary, or economically challenging as you may think.

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


Acquisitions, Funding, Business, and Stock

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Patient navigation software and services vendor Care Continuity raises $10 million.

Impact Advisors acquires payer-focused First Quadrant Advisory.

GE HealthCare will acquire medical imaging analysis software vendor MIM Software.

Medical record retrieval and analysis software startup Credo Health raises $5.25 million. CEO Carm Huntress, founder and former CEO of RxRevu, launched the company nine months ago.

Food and environmental services outsourcer Aramark will offer the hospitalized patients of customers of its clinical nutrition service the ability to connect with its dietitians via the hospital’s preferred telehealth platform. 

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Harris acquires the Medstreaming vascular and cardiovascular reporting, practice management, and billing solution of Fivos, which Harris will offer under its Picis brand.


Sales

  • Tallahassee Memorial HealthCare selects Ensemble Health Partners for revenue cycle management.
  • Premier Orthopaedic and Hand Center (IL) selects EHR and patient engagement software from EClinicalWorks.
  • VHC Health in Washington, DC will implement RCM software and services from Med-Metrix. Two hundred VHC RCM staff will transition to employment with Med-Metrix as part of the 15-year contract.
  • California-based HIE SacValley MedShare selects Health Catalyst’s data and analytics technology and professional services.

People

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NextGen promotes Srinivas Velamoor, MBA to president and COO.

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Ingeborg “Inge” Garrison, RN, MSN (RLDatix) and Amanda Heidemann, MD (KeyCare) join EVisit as principals of clinical strategy.

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Deb Anderson, MBA (Advocate Health) joins Endeavor Health as CIO.

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Caleb Hartman (Gozio) joins Loyal as VP of sales.


Announcements and Implementations

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Hartford Healthcare (CT) begins offering virtual care at select retail and community locations via OnMed health stations.


Government and Politics

ONC’s HTI-1 final rule is published in the Federal Register with an effective date of February 8. The rule covers algorithm transparency, USCDI Version 3 as a baseline certification standard, enhanced information blocking requirements, and new interoperability-focused reporting metrics for Certified Health IT.


Privacy and Security

Refuah Health Center (NY) will pay $450,000 in penalties and costs and will invest $1.2 million in cybersecurity improvements to settle New York State charges that it failed to protect patient information in a May 2021 ransomware attack. The state says that the hackers gained access to the FQHC’s security cameras that was protected by a static, four-digit code; moved from there to its private network; then used the login credentials of one of its IT vendors that had been unused since 2014 to gain access to its systems.


Other

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Withings unveils its BeamO “multiscope.” Designed for use during home-based virtual visits, the device acts as a digital thermometer, electrocardiogram, oximeter, and stethoscope. The company anticipates launching the product and its accompanying app in at select retailers in July for $250.

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OhioHealth equips its new Pickerington Methodist Hospital with smart room technology from EVideon.

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Healthcare think tank The Lown Institute announces the winners of its 2023 Shkreli Awards:

  1. Columbia University, for failing to stop the sexual assaults of one of its OB-GYNs despite complaints from 250 patients, with the resulting lawsuit costing it $235 million to settle.
  2. Non-profit Catholic hospital operator CommonSpirit Health, which paid its CEO $36 million in 2021.
  3. Drug companies that are challenging a new law that allows Medicare to negotiate drug prices with manufacturers for the first time, which they claim violates their constitutional rights.
  4. Hospitals that have partnered with private equity firms to offer high-interest medical credit cards.
  5. A doctor who has been disciplined by 12 state medical boards and settled Medicare fraud allegations related to performing unnecessary procedures who failed a mandated ethics course twice and is still practicing medicine.
  6. Drugmaker GlaxoSmithKline, which hid evidence that its Zantac heartburn drug caused cancer.
  7. An Indiana cardiologist who catheterized a single patient 44 times to implant 41 stents.
  8. Hospitals who were caught dumping homeless patients onto the street.
  9. A surgeon who implanted two expensive, experimental Medtronic devices into a patient of a hospital that serves mostly low-income patients, after which the patient had a stroke that caused with long-term damage.
  10. A Pennsylvania hospital that gave the family of an undocumented immigrant 48 hours to pay $500 per day for at-home medical equipment, find a hospital that would accept her transfer, or consent to be medically deported to the Dominican Republic.

Sponsor Updates

  • Arcadia joins Atropos Health’s Evidence Network.
  • The Thriving Practice Podcast features Arrive Health CEO Kyle Kiser, “On a Mission for Affordable Medications.”
  • Clearwater Executive Chairman Bob Chaput releases a new book, “Enterprise Cyber Risk Management as a Value Creator.”

Blog Posts


Contacts

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

Morning Headlines 1/9/24

January 8, 2024 News No Comments

Amazon introduces new Health Condition Programs—here’s what you need to know and how to enroll

Amazon launches Health Conditions Programs, an online service that helps Amazon account holders find and enroll in digital health programs covered by their insurance plans.

Care Continuity Secures $10M in Funding to Fuel Growth in Patient Navigation

Patient navigation software and services vendor Care Continuity raises $10 million.

GE HealthCare announces agreement to acquire MIM Software

GE HealthCare will acquire medical imaging analysis and AI-enabled workflow software vendor MIM Software.

Ventra Health and Advocate RCM Combine Forces

RCM and advisory services company Ventra Health acquires Advocate RCM, which specializes in RCM software and services for certain specialties.

Curbside Consult with Dr. Jayne 1/8/24

January 8, 2024 Dr. Jayne 1 Comment

This weekend was all about playing cleanup. The new year brings a lot of things for the physician to-do list, one of which is starting my quarterly questions that are needed for me to maintain my specialty board certification.

The Maintenance of Certification (MOC) process is almost universally hated by physicians, to the point where some of them will take a high-stakes exam every 10 years rather than participate in the program. I was part of my specialty’s pilot program for MOC and much prefer the quarterly questions to an all-day exam, especially since I haven’t practiced full-spectrum primary care in quite a while. Unfortunately, my specialty still thinks we should be able to manage all the conditions we used to manage during our residency training programs, so I have no choice but to play along.

The quarterly MOC questions are open book, so that’s something, and usually if I don’t know the answer, I can find it using a combination of UpToDate, the online version of my specialty’s flagship journal, and the website of the US Preventive Services Task Force.

Arriving in the New Year also means paying an annual fee to the board, which I had forgotten about. Many of my colleagues who are in purely informatics roles have to pay these expenses out of pocket, which is burdensome. The boards assume that physicians are either self-employed and can take their board fees as a business expense, or that they are employed and receive reimbursement from their practice, hospital, or health system.

There’s a lot of chatter in the physician world right now about the value of MOC, with oncologists and cardiologists being among the most recent to launch challenges. Usually, physicians have to maintain particular board certifications approved by the American Board of Medical Specialties in order to be granted hospital privileges and to join insurance plans. However, there’s a movement towards supporting an alternate organization, the National Board of Physicians and Surgeons. Although it’s gaining traction, NBPAS isn’t accepted in my area, so I haven’t pursued it.

Some clinical informaticists see MOC as an opportunity where AI tools might help physicians trim the time-consuming process. Rather than having to search three or four websites, one could query a generative AI system to provide the information that is needed to answer the questions. Physicians could also perhaps ask a virtual assistant to search the rules and regulations for their specialty and create calendar appointments for all the deadlines that are required to maintain certification. For those of us who have multiple board certifications, that might help a lot, especially since each board has its own timeline and requirements that differ depending on where you are in your certification cycle. The questions I did this weekend didn’t have any disclaimer that you couldn’t count AI tools as some of the online resources used in answering the questions, but I’ll have to keep my eye out for such prohibitions in the future.

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Also on my list for the weekend was setting up a new laptop that was sent by a client I recently started working with. This is the first time I’ve had Microsoft balk at my use of a password that doesn’t contain words. I’m not sure how someone would guess a 10-character password that contains two numbers, three lowercase letters, three uppercase letters, and two symbols or why Microsoft would have seen my particular combination of characters “too many times.” I certainly don’t use the same password on all of my accounts, so this just seemed like a weird error. I had to try three versions of what I wanted to use before it finally gave up and let me set my password.

I also caught up on some reading, which put me to sleep the first time I tried to get through it. ONC is scheduled to publish its “Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing” final rule this week. The rule implements pieces of the 21st Century Cures Act through the creation of new requirements for health IT developers under the Health IT Certification Program. The rule includes provisions for developers to report metrics that give insight into how organizations are using certified IT products, updated criteria for decision support interventions, and updates to patient demographics and electronic case reporting. It also requires developers to move to the United States Core Data for Interoperability (USCDI) Version 3 standard no later than January 1, 2026. This will help organizations better share data that will promote health equity, reduce healthcare disparities, and improve the interoperability that is needed for public health efforts.

Of course, no ONC final rule would be complete without a mention of information blocking, and I can assure you that’s in there, at least in the current unpublished version that’s available on the Federal Register website. Its 804 pages of double-spaced delight isn’t much of a beach read, but it contains other hot topics, including a C-CDA Companion Guide update, a Synchronized Clocks Standard, information on a patient’s Right to Request a Restriction on Use or Disclosure, and more. The rule will become effective 30 days after it is published in the Federal Register.

The final cleanup activity of the weekend was catching up on a New Year’s Resolution on which I had already fallen behind. This year, I’m aiming to read two scholarly articles each week that cover an area of medicine or clinical informatics that isn’t part of my usual practice. One of my articles this week was “Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use.” The article, which was published in JAMA Internal Medicine, covers a randomized clinical trial designed to see if a program for patients with diabetes that provides healthy groceries, dietician consultations, education, and health coaching would improve blood sugar control in compared to the usual care they would otherwise receive. The study had over 400 participants. Although the authors didn’t find an improvement in blood sugar control, they did find improved patient engagement in preventive health care interventions. They recommend that additional studies be performed to find optimal “food  as medicine” interventions to improve patient health.

Since this resolution was designed to stimulate my curiosity, I wandered around the internet a bit to learn more about food-based medical interventions. I was intrigued by The Goldring Center for Culinary Medicine at Tulane University. The Center has been around for more than a decade and was designed as a teaching kitchen to educate future physicians “to understand and apply nutrition principles in a practical way” and to better work with patients on diet and lifestyle modifications. The Center also provides cooking classes for the community. I was glad to see that they offer continuing education classes for practicing physicians since many of my medical classmates subsisted for anywhere from seven to 10 years on a diet of ramen, sandwiches, drug rep-provided lunches, leftover patient meals, and a stash of graham crackers and apple juice that was liberated from nursing unit stockrooms.

New Orleans is a great city. Anyone up for a HIStalk continuing education field trip? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Importance of Well-Managed Patient Identity Queues

January 8, 2024 Readers Write No Comments

The Importance of Well-Managed Patient Identity Queues
By Megan Pruente, RHIA, MPH

Megan Pruente, RHIA, MPH is director of professional services for Harris Data Integrity Solutions of Niagara Falls, NY.

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Identity queue management is an important aspect of an effective value-based care strategy. It lays the foundation for establishing an effective person index, minimizing overlays, and facilitating streamlined care coordination. Left unresolved, backlogged work queues can have costly implications for patient care and safety, as well as revenue integrity.

However, many provider organizations are struggling to stay ahead of burgeoning identity error queues, with health system clients reporting that weekly error tasks have more than doubled. At one health system, the volume of potential overlays queue swelled from 2,000 per week to more than 5,000 per week over the course of just a few months, while another organization found itself dealing with a backlog of 100,000 identity interface errors. The health information management (HIM) director at a third health system shared that his team evaluated up to 400,000 potential overlay tasks in the last year to identify just 60 true overlays.

Many HIM departments lack the staff resources and experience that are necessary to address this volume of mismatched data, and the backlog continues to grow. What’s more, many hospitals and health systems may not be catching potential overlays or identity interface errors because their EHR systems lack the functionality or tools that alert end users to such errors.

Blame for this surge in errors can be traced back to several events, starting with the pandemic. The rapid uptick in adoption and use of patient portals, implementation of self-registration processes, and internal workflows to accommodate telemedicine and vaccination appointments led to a sharp increase in overlays, duplicates, and other identity-related errors. Exacerbating this were staffing shortages created by illnesses, caring for sick loved ones, and an exodus of healthcare professionals due to fears of COVID-19 and burnout, an ongoing challenge that has identity management teams stretched to the breaking point.  Another factor involves changes to fields that are used to capture patient identity data, such as expanded options for sexual orientation and gender identity (SO/GI).

Ironically, some of the blame also lies with the EHR workflow tools that were designed to address patient identity management challenges. For example, Epic’s EMR includes a Possible Overlay Queue, a useful workflow tool that identifies and segregates potential overlays until they can be analyzed and either verified or cleared from the queue if it is determined not to be a true overlay. However, its sensitivity to any change to the patient’s demographic information, whether significant (a name change or new Social Security number) or routine (adding a middle initial or completing SO/GI fields) can sometimes lead to an increased backlog volume as every alteration triggers an overlay task to be added to the queue.

Similarly, when data such as order results and documents cannot be filed automatically into a patient’s existing medical record due to a mismatch or fuzzy match on demographic data points, medical record number (MRN), or other patient-level data point, these messages error out and must be manually reviewed and resolved. When left unresolved, these errors can lead to repetitive orders, duplicate tests, and other issues that could result in denied claims.

The challenge for HIM is that some EHRs do not have interface error work queues that streamline resolving such errors. Even when EHRs do offer such functionality, staff often struggle to keep up with the high volume of errors requiring attention.

The reality is that managing identity error backlogs is a time-consuming and resource-intensive task that few HIM departments have the capacity to handle. The intricate nature of these processes requires meticulous attention to detail and often diverts focus from more critical tasks and strategic initiatives. Exacerbating the challenge, new tools and reports being released to HIM designed to help address duplicate, overlays, and interface errors are contributing to the increase in workload with the same or fewer resources to review the errors.

Healthcare organizations can take a number of actions to reduce the volume of identity errors and prevent backlogs from spiraling out of control. These include:

  • Invest in staff training. Provide comprehensive training to enhance HIM professionals’ identity management skills. Keep staff updated on changes in patient data capture fields and the use of EHR workflow tools to reduce errors caused by lack of awareness.
  • Prioritize staff resources. Allocate adequate staff resources to address identity queue backlogs and ensure that HIM departments have the capacity to handle the volume of tasks. Also, consider hiring additional staff or redistributing existing resources to focus on resolving identity errors and preventing the backlog from growing.
  • Collaborate across departments. Foster collaboration between IT, HIM, and other relevant departments to collectively address identity management challenges. Also, establish cross-functional teams to develop and implement solutions that consider the perspectives and requirements of different stakeholders.
  • Outsource MPI management. Evaluate the cost-effectiveness and efficiency of outsourcing MPI management to a vendor or partner with experienced staff overseen by credentialed professionals. Short-term MPI management support should also be considered during M&A activities to ensure integration of clean data and quick turnaround times.
  • Implement robust data governance. Establish a strong data governance framework to ensure the accuracy and integrity of patient data throughout its lifecycle, including ongoing quality checks to ensure the accuracy of any automation and other patient matching tools, including AHIMA’s Naming Policy Framework and the Project US@ AHIMA Companion Guide.
  • Enhance EHR workflow tools. Collaborate with EHR vendors to fine-tune sensitivity of algorithms to reduce false positives in the identification of potential duplicates and overlays and to customize workflow tools that better align with the organization’s specific needs and processes.
  • Use third-party data. Use third-party data like historical addresses and phone numbers that are obtained from outside vendors to help prevent and accelerate remediation of overlays.
  • Invest in enhanced patient matching tools. Biometrics and other patient matching technologies can prevent the creation of identity errors by improving accurate identification during front-end registration processes.
  • Automate data matching processes. Explore, implement, and closely monitor advanced technologies such as machine learning and AI to automate matching and reduce the reliance on manual reviews. Integrate systems that allow for automatic filing of order results and documents into patient records to minimize errors related to mismatched data.
  • Use analytics for insights. Use analytics tools to gain insights into patterns and trends that are related to identity errors and to identify root causes.
  • Regularly monitor and evaluate processes. Implement a continuous monitoring system to track the performance of identity management processes and identify areas for improvement. Regularly evaluate the effectiveness of implemented solutions and work closely with IT staff or vendors to optimize processes, as even seemingly minor AI errors can have significant and widespread impacts.
  • Don’t overlook the patient’s role in maintaining clean patient identity queues. Implement patient education programs to encourage accurate self-reporting of demographic and other relevant information. Also, promote to patients the importance of maintaining up-to-date and accurate information, including creation of talking points to help staff engage in these discussions.

Unresolved identity errors pose a significant threat to a hospital’s financial health. These errors can lead to reimbursement delays, costly repeat studies, and denied claims, creating unnecessary financial strain. A backlog can also impact patient care by creating gaps in medical histories, unnecessary delays in diagnosis and treatments, and risks to patient safety.

To avoid these impacts, patient identity error queues should be part of an overall MPI management strategy. Whether outsourcing to an outside MPI vendor or increasing internal resources to put in place workflow processes for eliminating the backlog and sustaining ongoing management, hospitals and health systems must prioritize patient identity queue management. Doing so empowers healthcare institutions to optimize operations that are being dragged down by unresolved patient identity errors, generating measurable cost savings, mitigating financial setbacks, and creating room for strategic investments in areas that truly matter.

Readers Write: My Crystal Ball for 2024: PR and Marketing Predictions

January 8, 2024 Readers Write 1 Comment

My Crystal Ball for 2024: PR and Marketing Predictions
By Jodi Amendola

Jodi Amendola is CEO and founder of Amendola Communications of Scottsdale, Ariz.

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2023 will be remembered for a lot of things. Unfortunately, one of them was unpredictable decision-making about investments in HIT solutions and longer sales cycles.

Looking at the year ahead, we may see some continued challenges when it comes to market conditions, but here’s hoping my 2024 public relations (PR) and marketing cheat sheet can help you better navigate uncertain waters.

Bet on LinkedIn

In my predictions for 2023, I shared concerns about the uncertain future of what was then Twitter (now X) when it comes to B2B social media programs. Since then, things have gotten increasingly worse. Under Elon Musk, major advertisers have fled, countless users are deleting their profiles, and even the President of the United States felt compelled to condemn Musk for an anti-Semitic tweet and left X in favor of the emerging social media platform Threads. Companies that remain on X should ask themselves whether the shrinking benefits outweigh the mounting negatives. 

Meanwhile, LinkedIn continues to lead the charge as the business marketing platform to embrace. LinkedIn has strategically added business-friendly features such as product pages, post scheduling, and enhanced content analytics. Businesses that have not embraced LinkedIn for marketing and sales are missing a tremendous opportunity.

To maximize LinkedIn, be authentic and provide relevant information on a consistent basis. No more than 20% of your corporate posts should be about your company. The remainder should focus on third-party content that sparks interesting industry conversations. LinkedIn posts should leverage storytelling for engagement, how-to-guides for interest, and thought leadership for conversations.

Maximizing Conferences: Booths, Networking, and Online Events

In 2022, people flocked back to the big healthcare conferences, eager to gather again in person in the wake of COVID-driven isolation. We saw healthy crowds again in 2023, but many companies are re-thinking this strategy in favor of hosting targeted breakfasts or dinners or attending events for networking purposes only. We will likely see that trend continue in 2024, as many businesses may decide that the cost of sponsorship and exhibiting are too high in a tight economy.

The pandemic forced companies to become creative in marketing through virtual events. At the time, these tactics were driven by safety concerns, but now it’s budget priorities. HIT marketers are realizing that they don’t need an expensive 10×12 booth on a crowded convention floor to get their message across.

If webinars, podcasts, and virtual roundtables are carefully targeted and well marketed, you can even reach more qualified prospects than you can at a live event. Virtual events are not only less expensive, but they can be held more often than in-person happenings. Content from virtual events also can be repurposed for sharing through social media, blog posts, and bylined thought leadership articles that you can place in high-value media outlets.

AI is Here to Stay, But Regs Are Coming (Hopefully!)

After disrupting so many professions in 2023, OpenAI experienced its own chaos and upheaval at the end of the year.

However, that particular situation is resolved and artificial intelligence — whether it’s from OpenAI or a competitor — is too powerful to be stopped by C-suite struggles. AI will continue to disrupt not only health tech, but also marketing and PR.

In 2024, marketing departments and agencies will get a better handle on what they can and should do with this emerging technology. AI, when used correctly in a PR and marketing setting, can be a valuable tool, but it will never be a substitute for human writers and human intelligence. It can be useful for research, ideation, and facilitating the writing and thought process, but not for creating creative, thoughtful, highly targeted content.

I expect 2024 to see greater efforts, both public and private, to regulate the use of AI and require disclosure when it is employed.

Uptick in Rebranding is Here To Stay

The past year was a big one for companies that are rebranding (or doing a brand refresh) and updating messaging. We will likely see more of these efforts ahead.

Sometimes a rebrand is necessary because a company expands, changes its offerings, or decides to enter a new market. In other cases, it’s because the old look and old messaging have gone stale, which can happen without a business even realizing it. While a top-to-bottom rebrand is not something undertaken lightly, it’s a necessary part of most corporate evolutions and can help a company re-position or re-invent itself when appropriate.

Video, Video, and More Videos

Regardless of the platform, video is an increasingly popular choice to provide a welcome alternative to the written word. People often prefer to watch or listen to a video for entertainment, education, or just a needed break from reading. Video on LinkedIn increases linger times and engagement, so the algorithm pushes it to more users. The best part: video doesn’t have to be incredibly high production or sophisticated to be effective. Expect video to assume a larger share of marketing content in 2024.

Shorter, Digestible Content Is Preferred

The days of writing 30-page whitepapers and e-books and expecting your audience to download and actually read them are largely over.

In most cases, audiences don’t have the time or patience for content that long or complex. They want relevant information delivered in shorter format such as issue briefs, LinkedIn articles, blog posts, infographics, and videos.

Key In on Customer Champions

If 2024 proves to be as tumultuous for healthcare as most expect, companies will need PR and marketing more than ever. Staying on brand and on messaging through chaotic times means having a consistent and ongoing share-of-voice to rise above the noise and cut through the chatter. The key is to leverage your customer champions and unique industry data to be relevant and demonstrate your key differentiators over the competition.

Do you agree or disagree with my predictions? Come back in a year and we’ll see how many I got right.

Regardless of your technology, product or service, I hope the New Year provides endless possibilities for growth and success. Here’s to leveraging lessons learned, flawless execution, and advancing healthcare.

Readers Write: Empowering Nurses Through Interoperable Technology: Revolutionizing Patient Care in the Acute Environment

January 8, 2024 Readers Write 1 Comment

Empowering Nurses Through Interoperable Technology: Revolutionizing Patient Care in the Acute Environment
By Elizabeth Anderson, RN

Elizabeth Anderson, RN, MSN is director of clinical experience and solutions at Rauland of Mount Prospect, IL.

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The acute care environment represents a dynamic hub of activity, with nurses positioned at its epicenter. Nurses spend long hours managing patient care, coordinating resources across interdisciplinary teams, and providing support to patients’ family members.

Although nurses strive to create positive experiences for their patients, a recent report from Leapfrog Group’s hospital ratings have illuminated a concerning decline in nurse communication, doctor communication, and staff responsiveness in hospitals nationwide. The disconcerting results accentuate the urgency for healthcare institutions to assess the resources provided to nurses and not the capabilities of the nurses. Increasing the number of checklists to complete and equipment to track creates barriers for nurses to work at the top of their licenses.

Hospitals should drive towards integrating solutions that allow nurses to spend more time providing direct patient care. Implementing technologies with true interoperability will assist in streamlining workflows and reduce the volume of decisions that need to be made by clinicians every hour. When nurses are equipped with the appropriate tools for their patient care space, the resultant improvements in outcomes can impact all areas of patient and staff satisfaction.

The pursuit of interoperability within healthcare remains an enduring aspiration, often obstructed by the prevalence of disjointed systems that foster isolated data silos. Consequently, nurses are compelled to navigate multiple platforms for a single clinical decision, leading to cognitive burden that can impede response times and patient satisfaction. The proliferation of technology in patient care has resulted in an average of 10-15 connected devices per patient room. However, not all these devices are optimized for clinical workflows or seamlessly integrated into crucial healthcare systems. Non-clinically vetted or non-interoperable technologies add unwarranted complexity and impose a cognitive burden on nurses.

Purpose-built solutions, such as converged platforms that are tailored to automatically access role-specific data and workflows, streamline tasks, and eliminate unnecessary steps are positive solutions that begin to address current state clinical needs. Equipped with a holistic view of the patient’s condition, nurses can administer personalized care, anticipate patient needs, and avoid medical errors.

Interoperability also curtails redundant communication and paperwork, affording nurses more time to operate at the pinnacle of their abilities and spend valuable time at the patient’s bedside. Outcomes of interoperable healthcare solutions establish harmonized data from various devices in patient rooms and offer a unified data repository that can provide the clinical teams with a global awareness of their patients’ needs that reduces decision fatigue and allows nurses to feel in control of their shift.

Interoperability serves as the linchpin in bolstering nurses and realizing the quadruple aim: enhancing patient experience, advancing health outcomes, reducing costs, and refining clinician experience. Empowering nurses with integrated data and analytic tools refocuses their roles from data-entry to proficient patient advocates. The realization of a connected care team through interoperability solutions is instrumental in manifesting the vision of coordinated, value-based care. Recognizing nurses as the lifeblood of healthcare mandates that they are equipped with the insights and technology requisite to fulfill their life-saving responsibilities.

Providing nurses with clinically tested resources and removing technology barriers that obstruct direct patient care can reverse the downward trajectory of reported satisfaction scores for hospitals. A patient-centric approach, characterized by patients feeling heard, cared for, and secure, leads to superior outcomes, fewer preventable events, and a more sustainable healthcare system overall. Patient experience must persist as the cornerstone of any high-caliber healthcare organization. By deploying the right solutions and technology for nurses to focus on bedside care, hospitals can attain commendable success in their endeavors.

Morning Headlines 1/8/24

January 7, 2024 Headlines No Comments

Cracks Appear In Walgreens Clinic Strategy As Patient Panels Go Unfilled

Walgreens Boots Alliance struggles with the performance of primary care chain VillageMD, in which it is the majority shareholder, having already closed 27 of the 60 underperforming practices.

Credo Health Announces Oversubscribed $5.25 Million Series Seed Funding

Medical record retrieval and analysis software startup Credo Health raises $5.25 million.

Announcing Our $24M Series B Funding Round

France-based GPT clinical note generator Nabla raises $24 million in a Series B funding round that values the company at $180 million.

Attorney General James Secures $740,000 from Online Mental Health Provider for its Burdensome Cancellation Process

Online mental health provider Cerebral will pay $540,000 in refunds to New York patients in a settlement with the state’s attorney general, who says the company intentionally made it hard for patients to cancel their subscriptions and instructed its employees to submit fake positive reviews.

UpDoc Debuts the World’s First AI Assistant That Manages Medication Prescriptions and Chronic Conditions

UpDoc announces a new funding round alongside the launch of its AI assistant that manages chronic conditions and prescriptions.

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