Curbside Consult with Dr. Jayne 6/21/21

I’m a little over a month past my departure from the world of brick-and-mortar patient care. Since then, I’ve been seeing patients in a couple of different telehealth venues, and it’s been a good experience overall.

Putting on my clinical hat, I would say the biggest weaknesses of the systems I use are that they don’t have the same EHR features as you would find in an in-person practice. Sometimes that makes it difficult to understand the patient’s history or their medication list, but given the transactional nature of urgent care telehealth services, it’s not insurmountable. I never thought I would say that I felt “spoiled” by having a certified EHR with all the bells and whistles, but maybe that was the case.

Most of my friends who are in traditional practice settings are still doing some percentage of their visits as telehealth, even as the pandemic eases. This applies to both specialists and subspecialists. Even surgeons are doing plenty of virtual visits, especially in the post-operative, follow up, and second opinion arenas.

Patients like the convenience, but I hear a lot of stories about physicians trying to juggle virtual and in-person appointments in the same day. There are plenty of initiatives across the US to make telehealth a permanent fixture in our healthcare system and the majority of people I’ve spoken with think this is a good idea.

The few naysayers that I’ve heard from are concerned that telehealth is becoming a way for physicians to increase their bottom line, performing telehealth visits where they previously might have a phone call with a patient. This leads to a concern that telehealth will drive up overall healthcare expenditures. Kaiser Health News cites data from PitchBook that the yearly global telehealth market could top $300 billion by 2026, nearly five times the levels seen in 2019.

I don’t doubt that there are bad actors in some organizations that claim to be offering telehealth. Certainly I’ve heard the stories about the two-minute visits and the services that essentially sound like pill mills. On the other hand, I’ve heard the stories of patients spared hundreds of miles of travel in order to get second opinions along with those who are now able to see subspecialists of a caliber not available in their home communities.

I’m trying to arrange a telehealth consultation for a family member who requires genetic testing. Their insurance carrier will only pay for the testing if it is ordered by a genetic counselor, who typically doesn’t perform a physical exam and so there’s not a lot of need for an in-person visit. The patient has had multiple physicians recommend the testing and understands the ramifications of testing, so requiring the additional visit feels like a barrier to care, especially since the patient is an hourly worker in an essential field.

There’s no question that telehealth needs to fit into the overall plan of care for patients, and that it shouldn’t be another source of fragmentation. I’m not sure how well the direct-to-consumer telehealth companies do with sending records back to the patient’s primary physician or other members of the care team. From what I hear, interoperability is pretty low unless the patient belongs to a health system who has partnered with the telehealth company.

In my past life as an urgent care physician, I frequently saw patients who had been referred for in-person care by a telehealth physician who felt that the patient’s condition wasn’t appropriate for telehealth or for specific testing, such as a rapid strep test or a COVID-19 test. Out of curiosity, I always asked which platform the patient had used, and very few of them actually knew the name of the service. Usually they arrived at it from an employer website, so I’m not sure the telehealth platforms are creating much loyalty beyond that with the employer representatives who handle the contracting.

I also saw plenty of patients who had been treated via telehealth in a manner that was inconsistent with the current standard of care. Often these patients came to urgent care because they weren’t getting better or because they had spoken with a friend or family member who said the course of treatment didn’t sound right. Those visits frequently require some degree of finesse because you don’t know exactly what happened in the previous visit or how the patient’s symptoms might have changed between that time and your visit.

Other times, however, you know the care provided didn’t pass the sniff test, especially when patients were given antibiotics that were not indicated for a given diagnosis or when they pull up their visit summary documents on their phones and the care plan can only be described as off the wall. We certainly see those issues play out from in-person care encounters as well, so it’s not necessarily a telehealth problem.

Being in the telehealth trenches allows me to do my work from anywhere, which I tried out for the first time recently. It was a little strange to pack my required white coat in my suitcase along with my sunscreen and flip flops, and I have to admit I was worried about whether I could get the right camera angles to make it look like I wasn’t in a hotel, but everything worked out. I still think that wearing a white coat to show that you are a physician (versus wearing it because it has nice pockets to hold all the things you need) is a little strange, but it’s required on my platform as a sign of professionalism. Personally, I wish the white coat would become extinct for infection control purposes, but it will probably stick around for the remainder of my career.

I see a need for large organizations, especially integrated delivery networks, to spend some time thinking through their telehealth strategies and make sure they make sense for growth and care delivery since many of them reached their current states out of desperation and necessity. There are still plenty of people out there using freestanding telehealth platforms that force physicians to do a lot of data entry and double work, and for their sake, I hope they can transition to integrated systems. The next two to five years will be interesting as far as seeing where telehealth takes us and what value it can deliver.

Ever talked to your doctor while she’s sitting on the beach? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Addressing the Public “Infodemic” Spurred by COVID-19

Addressing the Public “Infodemic” Spurred by COVID-19
By Denise Basow, MD

Denise Basow, MD is CEO of the Clinical Effectiveness business unit of Wolters Kluwer, Health.

The novel coronavirus proliferated around the globe with lightning speed, spurring an explosion of new medical information over the last 18 months. Care teams on the front lines were desperate to get their hands on the latest guidelines to treat the influx of patients streaming through their emergency departments, but were also faced with misinformation that could potentially harm their patients.

Similarly, patients struggled to understand which information sources to trust so they could protect themselves and their loved ones. The WHO has identified this deluge of information, or “infodemic,” as a primary concern for global health.

According to the WHO, the definition of an infodemic is “too much information, including false or misleading information in digital and physical environments during a disease outbreak, which can cause confusion and risk-taking behaviors that can harm health; it can also lead to mistrust in health authorities, undermining the public health response.”  

Consider that on January 31, 2020 there were 50 studies published on coronavirus within 20 days, which was remarkable progress. Today, there are more than 150,000 studies on coronavirus, with some estimates as high as 400,000 if we include preprint journals and other gray literature.

It is critical that someone make sense of all this information for it to be useful in treating patients, as there is a significant margin for error when considering the immense pressure to do so as quickly as possible to save lives.

While much of my career has focused on getting the latest evidence-based information into the hands of the clinician community to foster the best care everywhere, we can’t forget that patients are a critically important part of the healthcare team. They need the right information as well, and this information should align with the evidence their care teams are using to make treatment decisions.

Fortunately, there is a clear path for combatting misinformation that can lead to an infodemic, and it is critical that the healthcare community understands and embraces it now to mitigate future occurrences:

1. Listen to communities – of clinicians and patients – for the specific questions and concerns that they have.
2. Get the facts into the hands of those communities so they can accurately evaluate risk, particularly around new vaccines in the case of COVID-19.
3. Foster broad understanding of the internet’s ability to produce good and bad information to build resilience to misinformation.
4. Provide tools that empower communities to act, such as education on how to distinguish fact from fiction and everything in between.

Across the world, everyone from government and public health officials to healthcare providers, community leaders, and individual patients need help determining when it’s appropriate to act (or not act) based on the scientific evidence. Everyone should have access to evidence-based information that informs their decisions, and technology should help facilitate, not hinder, that access. We can and we must learn from the COVID-19 infodemic to improve future public health response.

Readers Write: Don’t Cut Corners in Hybrid Cloud Protection

Don’t Cut Corners in Hybrid Cloud Protection
by Pascal Geenens

Pascal Geenens is director of threat intelligence with Radware of Mahwah, NJ.

In the past few months, several high-profile ransomware attacks on healthcare facilities in Las Vegas, Oregon, and New York have resulted in delayed or suspended surgeries and interruption of other patient care, not to mention the loss of millions of dollars to the facilities themselves.

Ransomware is but one of several attack strategies that malicious actors have employed against healthcare facilities. For example, the number of distributed denial-of-service (DDoS) attacks targeting hospitals has also increased since the beginning of 2021.

Healthcare and security teams face incredible challenges following the pandemic. Although keeping patient data available and secure is critical, it is increasingly difficult due to the array of attack vectors and cybersecurity knowledge required to mitigate them. In addition, several mergers of healthcare providers have introduced additional complexity in networks that can overwhelm security teams.

Remote access and online services, such as streaming doctor/patient consultations and online electronic medical records (EMR), have seen exponential growth. Healthcare organizations have had to manage and secure large volumes of patient data and provide 24×7 access to critical applications to ensure a quality user experience and the ability to protect lives. As a result, healthcare remains one of the highest at-risk industries from cybercriminals.

Much of the issue can be traced to the transition — accelerated by COVID-19 — to public clouds, network-connected devices, and the move towards online and application-based services, which mean more vulnerabilities and data breaches. When healthcare services and applications go down, healthcare providers suffer productivity and operational losses, negative customer experiences, and intellectual property losses.

Based upon the results of several industry surveys, don’t expect this race to the cloud to revert. Hybrid cloud configurations are here to stay. Because of the new reality, IT administrators and hackers now have identical access to publicly hosted workloads, using standard connection methods, protocols, and public APIs. As a result, the whole world becomes an insider threat. Workload security, therefore, is defined by the people who can access those workloads, and the permissions they have.

The question then becomes, should healthcare enterprises focus protection on-premises or the cloud? The answer is unequivocally both.

Part of the reason is because another aspect to consider when moving applications to the cloud is the connectivity and accessibility of those applications. When the internet connection from the hospital is suffering from a degraded or total loss of connectivity, all activities come to a grinding halt. Protecting connectivity only with on-premises equipment leaves organizations too vulnerable. On-premises detection and mitigation alone prevented 85% of DDoS cyberattacks, but the other 15% required cloud DDoS protection. Because of the latency introduced by cloud DDoS protection, enterprises sometimes rely only on on-premises protection.

This is a mistake, because even though only 15% of attacks required cloud protection, those attacks represented 92% of attack volume and 84% of the packets. In hybrid deployments, the cloud handles the volumetric attacks while on-premise will typically handle low-and-slow and low-volume DDoS attacks, as well as anomalies and intrusions.

While healthcare organizations face unprecedented challenges, cutting corners in cyber protection isn’t a viable option. Especially during a rapid and complex transition to the cloud, enterprises can’t afford to neglect either on-premises or cloud protections.

Morning Headlines 6/21/21

Social network for doctors Doximity targets $4 bln valuation in U.S. IPO

Physician network operator Doximity files documents for an IPO that will value the company at $4 billion.

Letter urges closing Humber River’s ER until IT systems fixed after cyberattack, but hospital says it’s safe

ED doctors at Humber River Hospital in Toronto, Canada urge hospital leadership to close the ED until IT systems are restored from a June 13 ransomware attack.

Improvements Needed in Adding Non-VA Medical Records to Veterans’ Electronic Health Records

A VA OIG report finds that VA’s use of community care staff to scan patient records that are created by non-VA providers introduces errors due to a lack of standardized procedures, insufficient training, and lack of quality checks.

Monday Morning Update 6/21/21

Top News

Physician network operator Doximity files documents for an IPO that will value the company at $4 billion.

The company reported $207 million in revenue in its most recent year, with $50 million in net income.

CEO and co-founder Jeffrey Tangney, MBA, who also co-founded Epocrates, controls 60% of company shares, a stake that will likely be valued at over $2 billion.

Reader Comments

From Joel Klein: “Re: University of Maryland Capital Region Medical Center. It opened on June 12, relocating all patients who were at Prince George’s Hospital Center, which will close. Essentially, this was an Epic go live plus a simultaneous hospital move. A week in, things are fairly stable. Thanks as always for doing this blog. Super helpful.” Congratulations to the team there and to Joel, who is SVP/CIO at University of Maryland Medical System and a practicing ED physician. UM Capital Regional Medical Center is in Largo, MD and replaces the 75-year-old Prince George’s Hospital Center in Cheverly, MD, which I believe was running Cerner.

HIStalk Announcements and Requests

Many poll respondents think technology has improved healthcare mostly in the areas of consumer convenience, accessibility, and safety, but don’t think it has helped in important outcomes areas.

New poll to your right or here: Which action was most responsible for your getting the job you hold now? Poll choices are limited by practicality, so feel free to add a poll comment if your hiring was by other means.

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Sales

• Post-acute care services provider Charter Healthcare chooses Netsmart’s MyUnity EHR along with its solutions for electronic visit verification and referrals. 

People

San Joaquin County, VA promotes Mark Thomas, MBA (San Joaquin General Hospital) to county CIO.

Julie Bastien, MBA (Press Ganey) joins EVideon Health as VP of marketing.

Industry long-timer Mike Ruotolo (Office Practicum) joins prescribing technology vendor TroyRx as VP of sales.

Lisa Wild, MA (Kaiser Permanent) joins Ellkay as VP of payer market sales.

Primary care doctor and physician informatician Kennedy Ganti, MD is installed as president of the Medical Society of New Jersey. He is also president-elect of New Jersey HIMSS.

Announcements and Implementations

California launches its digital COVID-19 vaccination record system, built on the open source SMART Health Card Framework of VCI, whose members include Cerner, Epic, Meditech, Allscripts, HIMSS, and The Sequoia Project.

Sweden’s Region Västernorrland goes live on Sectra imaging.

Government and Politics

A VA OIG report finds that VA’s use of community care staff to scan patient records that are created by non-VA providers introduces errors due to a lack of standardized procedures, insufficient training, and lack of quality checks. The small review of records from seven VA facilities found that 44% of scanned mental health records contained errors that were caused by inaccurate document titles, indexing records to the wrong referral or veteran, and duplicate record entry.

ONC invites colleges and universities to apply for its public health IT workforce program, supported by $80 million in American Rescue Plan funds. ONC expects the program to train 4,000 people from underserved communities over four years.

Delegates at the American Medical Association Special Meeting call for doctors to be given more flexibility if they believe that the release of a patient’s health information – under ONC’s Cures Act information blocking requirements – would cause physical, mental, or emotional harm. They are especially concerned about doctors releasing the reproductive health, mental health, or substance abuse information of adolescents to parents or proxies as the regulation requires.

Privacy and Security

ED doctors at Humber River Hospital in Toronto, Canada urge hospital leadership to close the ED until IT systems are restored from a June 13 ransomware attack. The ED has gone to paper records and patients are experiencing long delays. The hospital opened in 2015 as North America’s first all-digital hospital and upgraded to Meditech Expanse in 2019.

St. Joseph’s / Candler (GA) is hit by a ransomware attack Thursday, with systems not yet recovered.

Other

The local paper profiles Peoria, IL-based OSF OnCall Digital Health, whose 800 employees operate a “hospital without walls” for OSF HealthCare and offer services to other organizations.

Sponsor Updates

• Hillrom posts an interview with SVP and Patient Support Systems President Paul Johnson, MBA on the company’s digital health vision.
• Wolters Kluwer Health offers Ovid users access to OrthoEvidence, an evidence-based summary provider for orthopedic specialists, surgeons, nurses, medical residents, and students.
• OptimizeRx discusses its 2021 strategic operating plan, which has been aligned with the pharma industry’s market-sizing opportunity across fast-growing specialty therapeutic areas.
• Well Health names Marissa Morrison (Foursquare) VP of people.
• PatientPing publishes a new use case spotlight, “How Eleanor Health utilizes PatientPing’s real-time ADT notifications to proactively and promptly engage members and coordinate care.”
• Premier honors with Community Enhancement Collaboration, a nonprofit dedicated to fighting food insecurity, with its annual Monroe E. Trout Premier Cares Award and a $100,000 cash prize.
• Redox releases a new podcast, “Crashing Primary Care and Dialysis with Dr. Andrew Schutzbank.”
• Spirion expands its Sensitive Data Platform portfolio with new SaaS solution offerings that simplify the protection of sensitive data across the enterprise.

Blog Posts

• Decoding Digital Health: Leverage Digital Health to Drive Improved Patient Outcomes and Commercial Success (OptimizeRx)
• Achieving Improved Patient Care Through Adversity: Hospice of Washington County and Care Synergy Discuss Challenge and Solution (Netsmart)
• Primary care is an essential part of a usable healthcare system (Nordic)
• Enhancing Your Find-a-Doc Solution to Increase Patient Volume and Loyalty (PatientBond)
• What are Comparative Billing Reports? (PMD)
• How to Solve Gaps in Care and Recover Patient Volume (Relatient)
• Informed and Unburdened: A Future System That Centers Patients on a Budget (Surescripts)
• How chatbots are changing – and improving – customer service (Talkdesk)
• Lessons from ISPOR 2021: The Increasing Acceptance of Real-World Data and Real-World Evidence in Regulatory Decision Making (TriNetX)
• 3 Top Benefits of Defining ROI for Patient Engagement (Twistle)
• How Video Conferencing is Improving Patient and Family Communication (Vocera)
• What Role Do Key Performance Indicators Play in a Practice, and Which Ones Should PTs Care About? (WebPT)

Contacts

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

Weekender 6/18/21

Weekly News Recap

• Former Athenahealth CEO Jonathan Bush launches health developer platform vendor Zus Health with a $34 million Series A funding round.
• Google Health is reportedly downsizing.
• A Wall Street Journal report says that Apple’s plan to run a wearables-focused virtual primary care service hasn’t been successful and the company is shifting its emphasis to selling Apple Watch.
• ONC publishes the first draft of its patient address standardization specification.
• AMA says EHRs should not present drug company advertising.
• Ambulatory surgery center software vendor HST Pathways acquires patient price transparency vendor Clariti Health.
• A security services vendor COO is indicted on federal charges of launching a cyberattack against Gwinnett Medical Center (now Northside Hospital Gwinnett).

Best Reader Comments

Doesn’t look like the stock market has given up on CERN yet. Still near all time highs. (Bob)

I found the prices published by a health system I currently have a billing dispute with. Will be interesting to see what they say when I ask them why my insurance company’s payment was insufficient for the services they provided when it is 4x the minimum negotiated charge. (Price Transparency?)

While the [DoD and VA Cerner] systems may be of the same origin, they are not the same today, and so there is that specific problem of non-identical systems. Additionally, the origin data is not anywhere near identical in schema, dictionary, enumeration, etc., so that will be a broader problem. Lastly, they haven’t exactly settled the solutions at this point, so they are driving at a moving target. Failing early might not be a bad strategy, but if someone isn’t setting that expectation, then someone is going to be mighty surprised in very short order. (AnInteropGuy)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Kentucky, who asked for a license to a learning platform to use in both in-person and remote classes. She reports, “”Your donation of the Nearpod Learning Platform has made a huge difference in the learning process for my English as a Second Language (ESL) students. Through this platform I have been able to modify their assignments to enable them to express their learning through drawing, matching, games, and voice recordings in addition to the tradition format of typing. The difference has been so great that my administration purchased Nearpod for the rest of our school. Now ALL students, not just ESL students are going to benefit. Thank you for helping me start this movement and show other how everyone can learn with the right tools and support.”

The charity RIP Medical Debt buys and forgives $278 million of hospital debt from Ballad Health, relieving the medical payment obligations of 82,000 low-income patients that in some cases go back decades. The charity says it works directly with hospitals that can turn bad debt into revenue without pursuing aggressive collection, address a major social determinant of health, and refine their charity care programs.

A federal court sentences a New York doctor to 57 months in prison for taking drug company bribes in return for prescribing Subsys fentanyl spray. Jeffrey Goldstein, DO took $200,000 in “speaking fees” for giving slide sessions for which attendee sign-in sheets were often forged and enjoyed an evening at a strip club in which drinks and lap dances were provided by company reps. He was the sixth-highest subscriber in the speaking program, generating $800,000 in sales in a single quarter of 2014 versus prescribing the drug just once before signing up for the speaking program. Federal agents also reported that during the speaking events, Goldstein drank heavily and used marijuana and cocaine with his staff. 

An Alabama nurse is fired and may have lost his license after he is shown in TikTok videos he posted as “@conservativecoy1776” where he says that COVID-19 isn’t dangerous and Anthony Fauci was paid to create it, claims that racism is an overreaction to what was actually a small number of slaveholders, and laughs at video of a patient who cried after receiving a high doctor bill in saying, “Hey, buddy, you better get used to saying that s***.” He made the mistake of recording some of his videos in a hospital room wearing his employee badge, which identified him and his employer, Baptist Health in Montgomery.

Emory University apologizes to a medical school applicant it rejected in 1959 with the explanation that the school was not authorized to admit “a member of the Negro race.” Marion Hood, MD says it was OK because he experienced discrimination every day and didn’t really expect Emory to admit him, but he was accepted and graduated at Loyola and then returned to Atlanta to open an OB-GYN practice that he ran for 34 years until he retired in 2008. Emory won its challenge of Georgia’s segregation laws in 1962 and admitted its first black student the next year. 

In Case You Missed It

• News 6/18/21
• EPtalk by Dr. Jayne 6/17/21
• News 6/16/21
• Curbside Consult with Dr. Jayne 6/14/21
• Monday Morning Update 6/14/21

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Morning Headlines 6/18/21

Zus Health Closes $34M Series A Led by Andreessen Horowitz (a16z); Participation from F-Prime Capital, Maverick Ventures and Others

Digital health developer platform vendor Zus Health, founded by former Athenahealth CEO Jonathan Bush, raises $34 million in a Series A funding round.

Google Health reportedly downsizing away from consumer focus

Google Health reportedly reduces headcount by at least 20% in a reorganization in which 170 employees have been moved to the Fitbit and Search product teams.

Form Health Secures $12M Series A For Obesity Telemedicine Platform

Boston-based Form Health will use a $12 million Series A funding round to expand its obesity-focused telemedicine service beyond the 16 states it currently serves.

News 6/18/21

Top News

Digital health developer platform vendor Zus Health, founded by former Athenahealth CEO Jonathan Bush, raises $34 million in a Series A funding round.

The company apparently abruptly changed its name from Zeus Health, which I noted a couple of weeks ago is already in use by a medical device investment company.

The press release explains that Zus is “pronounced Zoos like the father of Athena” although it declines to use the actual word “Zeus.”

Six of the company’s eight executives spent time at Athenahealth.

A lengthy Zus testimonial is provided by the CTO of Firefly Health, whose executive chairman is Jonathan Bush.

Reader Comments

From End Gamer: “Re: Cerner. I think we ex-Cerner executives have a fair bit of insight due to our deep network and rapid information exchange. The company’s first failure was the drag on leadership when Neal was sick – an interim CEO should have been named within six months. In the subsequent CEO search, at least two candidates turned the job down before Brent arrived. The Board absolutely dropped the ball here. As to the future, I don’t think it matters who gets the job. The ship has taken on too much water and Epic is beating the daylights out of Cerner in the US (and soon overseas). The all-in bet on Federal programs has committed Cerner’s IP org to the detriment of the client base. I would expect that someone that wants to get big in healthcare could buy the company, but regardless, the Cerner that we were part of is gone, as are its traditions, its passion, and its potential.” I would opine that one thing that Cerner did right with Brent’s hiring was attempting to diversify into new areas – such as data sales and new federal business – in recognizing that the Epic juggernaut was going to be hard to stop, especially as Cerner was losing clients because of its revenue cycle fumbling. I haven’t seen product line revenue and contribution breakouts, so I don’t know if Cerner is still mostly an EHR vendor or its growth has significantly shifted to areas where Epic doesn’t compete.

HIStalk Announcements and Requests

HIStalk sponsors who are exhibiting at or attending HIMSS21 – tell me about your participation by July 23 and I’ll include your company in my HIMSS guide.

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Acquisitions, Funding, Business, and Stock

The Wall Street Journal says that Apple’s health ambitions mostly haven’t panned out, although the article’s sources don’t seem solid. Apple planned to develop its own primary care service that would be powered by wearables data, but has since returned to its focus on selling hardware, particularly the Apple Watch. Insiders question the quality of the data generated by its clinics to guide product development, including the HealthHabit health coaching app, which has delivered poor user engagement among Apple employer testers. Company executives say data shows that HealthHabit improves blood pressure in 91% of its hypertensive users, while competing programs Hello Heart and Livongo deliver in the 30% improvement range, leading insiders to worry that Apple’s results are being overstated based on faulty data.

Google Health reportedly reduces headcount by at least 20% in a reorganization in which 170 employees have been moved to the Fitbit and Search product teams.

KHN reports that publicly traded hospital chain HCA is turning many of its hospitals into trauma centers, taking advantage of the ability to bill ED patients an “activation fees” of up to $50,000 each time the trauma team is assembled, sometimes when a routine ED visit is all that was needed. One man’s arm gash was billed at $52,000 instead of a reasonable $3,500. HCA’s activation fee in Idaho is $29,000 versus the state average non-HCA activation charge of $2,500.

Sales

• Aspen Valley Hospital will implement Epic as the board approves the $15.4 million expense to replace Meditech. The 25-bed hospital’s previous agreement with University of Colorado Health for a Community Connect fell through, but it says that Epic no longer requires rural hospitals to partner with a larger health system.
• Community Health Network will implement advance care planning document sharing from Vynca.

People

Virtual reality clinical training vendor Health Scholars hires Scott Johnson (CirrusMD) as CEO.

Gregg Shibata (Echo Health Ventures) joins Quil as VP of payer market development.

IdentifyIOT hires Jeff Powell as VP of healthcare sales.

Shannon Freiermuth (DrFirst) joins Change Healthcare as VP of strategic clients.

Industry long-timer John Goodrow, MBA (S&P Consultants) died Monday at 51.

Announcements and Implementations

Vyne Medical launches the cloud-based Refyne platform, whose initial capability is electronically transmitting supporting provider documentation in CMS’s Electronic Submission of Medical Documentation and Electronic Medical Documentation Request initiatives.

People who received COVID-19 vaccine from Walmart or Sam’s Club will be provided with a digital copy of their record using Health Pass by Clear.

Major Health Partners (IN) goes live with Meditech Expanse Patient Care as an early adopter.

Government and Politics

ONC publishes the Version 1.0 draft of the Project US@ Technical Specification, which hopes to create a unified specification for patient addresses that can also support patient record matching. The comment period will open soon. It is a surprisingly complex issue given the country’s language diversity, the imprecision of some addresses outside of urban areas, and the need to accommodate the different standards of Puerto Rico and the military.

A Defense Department MHS Genesis roundtable lists care improvements enabled by its Cerner implementation – real-time clinical decision support for newborns, improved tracking of service member health between duty station transfers, a reduction in visits for prescription management, and enhancing recruit readiness. The military says that the system improves care by standardizing workflows and processes.

Other

A Mayo Clinic study finds no association between COVID-19 vaccination and cerebral venous sinus thrombosis. Researchers used Nference’s AI software to review real-world evidence from several hundred thousand vaccinated patients, including lab results, unstructured clinical notes, and structured health records. Mayo and Nference launched Anumana in April 2021 to commercialize ECG analysis algorithms.

As just about everybody predicted, hospitals are declining to publish their insurer-negotiated prices as required by a federal law that took effect January 1, instead opting to pay the paltry $300 per day fine for failing to do so. Whoever came up with that fine amount must not have ever looked at a health system’s revenue.

An AMA Board of Trustees report finds that the top five EHRs don’t display drug ads, but it warns that such advertising should not be allowed at all in EHRs and electronic prescribing systems, citing abuses by Allscripts-owned Practice Fusion. The AMA House of Delegates changed its policy to require direct-to-prescriber EHR advertising to comply wiith AMA’s direct-to-consumer advertising guidelines. The policy also prohibits displaying brand name products first in drug lookups and encourages displaying the generic product first.

Sponsor Updates

• Premier recognizes Atrium Health with its Alliance Excellence Award for saving $100 million in supply chain costs and $140 million in clinical optimization savings using the PremierConnect cloud-based performance improvement platform.
• EClinicalWorks releases a new video, “EClinicalMessenger: Improving Healthcare Through Better Communications.”
• Arcadia announces that its Arcadia Analytics platform earned the highest ratings in the inaugural Cybersecurity Preparedness Evaluation from KLAS and Censinet.
• West Monroe expands its leadership team and promotes eight employees to partners.
• First Databank will exhibit at the NCPDP Annual Technology & Business Conference June 29-30 in Scottsdale.
• Halo Health publishes a new case study, “Improving Efficiency, Secure Communication at Thomas Hospital, Infirmary Health.”
• Imprivata receives a 2021 Fortress Cyber Security Award in the authentication and identity category from Business Intelligence Group.
• Infor will host its Inforum customer even November 9-11 in Las Vegas.

Blog Posts

• Why Patient Engagement Is Failing Us — and What You Should Do (Lumeon)
• How Regulatory Compliance Supports Optimal Patient Care and Higher Earnings (Health Catalyst)
• Attract More Patients with Health Education – 4 Ways to Up Your Online Game (Healthwise)
• Epic UGM 2021 Planning Guide: UGM is In-Person (Healthcare IT Leaders)
• Preference cards 101: The key to maximizing OR utilization (Intelligent Medical Objects)
• Optimizing Rural and Community Hospital IT Implementations During Times of Uncertainty (Medhost)
• Harnessing Healthcare’s Data Explosion with AI-based Natural Language Processing (Medicomp Systems)
• What to expect at Meditech’s 2021 Nurse Forum (Meditech)
• Measuring Employee Performance in Your Physical Therapy Practice (MWTherapy)

Contacts

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

EPtalk by Dr. Jayne 6/17/21

Today’s big news is the Supreme Court’s dismissal of a major challenge to the Affordable Care Act. This is the third time that the healthcare law has been upheld. This challenge was based on the concept that since the individual penalty portion was eliminated in 2017, the entire law should be struck down. The court voted 7-2 to block the suit, stating that the plaintiffs did not have appropriate standing to bring the case. I don’t think that we’re done with challenges to the Affordable Care Act, but I know that patients who count on its provisions are breathing a sigh of relief.

I ran across a great op-ed piece recently that focuses on how “humans are getting in the way of digital health.” It cites the piecemeal application of technologies as a major barrier to transformation as compared to other industries like banking or logistics, where everyone involved jumped on the bandwagon. Other challenges include a lack of technology education and training for the people who need to use digital health along with teaching stakeholders to assess the value of new technologies so that they can add the right systems at the right time. The author calls for meaningful provider education through structured training, including peer-to-peer training, formal education, and inclusion of evidence-based guidelines. These seem like they would be basic tenets for successful clinical / digital transformation, but there are a lot of organizations missing the boat.

I went to visit a new PCP this week. We used to work together and he knows my informatics background, so he was happy to give me a tour of my Epic chart after I asked if he could see the results of my recent genetic testing. It turns out they are buried as scanned documents. He noted that the governance and quality control on the scanning can be a bit lacking at times. Having done numerous quality improvement projects and revisions to organizations’ document management systems, I know what a pain it can be when documents are filed or tagged in the wrong place. Hopefully, the majority of their results are coming in electronically at this point, but I’m sure there’s plenty of scanning going on with referral letters, consultation letters, hospital discharges, and more.

He happily reviewed the blood pressures I had logged in the Withings Health Mate app on my phone. We both agreed with liked the display because it shows averages in numerical form that can be filtered by month as well as a graphically-based view that gives a red / yellow / green view of the ranges for a patient’s values. That’s the kind of data we need to be incorporating for remote patient monitoring rather than burdening physicians with thousands of data points that need to be sifted through. He agreed with me that my crazily high blood pressure a couple of months ago was likely due to a combination of work stress and too much ibuprofen. I enjoyed watching my lab results arrive throughout the afternoon and all was well, so I’m good for another year.

Business Insider reports that Google is shrinking its health team, reassigning 130 workers from its health division into other areas of the company such as Search and Fitbit. The company restated its commitment that Google Health “will continue to build products for clinicians, conduct research to improve care and make people healthier, and to help ensure all health-related projects at Google meet the highest standards.” The count of those employees has now dropped to 570 from a March headcount of 700.

The publication also reports that Walmart Health has filed documents to expand its virtual care solution to 16 additional states, doubling its count. I don’t know anyone who has used the company’s telehealth offering, but would be interested to share (anonymously, of course) any reader experiences. The company’s brick-and-mortar offices are limited to a handful of states, so we’ll have to see how long it takes them to cover the entire US for telehealth.

Meanwhile, CNBC reports that Amazon Care has signed multiple corporate clients who plan to make use of its telehealth services. They’re holding announcement of those names until later in the summer, but I’m extremely curious – if anyone has rumors they would like to report anonymously, we would be happy to entertain them. The program was launched in 2019 as an internal employee benefit and includes virtual urgent care visits, free telehealth consults, and fee-based in-home visits for testing and vaccinations.

Having been part of the healthcare IT industry for a while now, I’ve been exposed to various company cultures. Some have included some hard-partying aspects and a fair amount of alcohol consumption. One vendor I worked with had an open beer tap in the office on Fridays, while another frequently referred to its staff as “a drinking company with a software problem.” That seems to have become a bit more tame in recent years, but I came across an article mentioning concerns that increased alcohol use could be a secondary consequence of the pandemic. Especially with work from home, juggling household responsibilities, economic worries, and the stress of the pandemic itself, alcohol use is on the rise. Given pandemic precautions, it will be interesting to see what the level of alcohol consumption looks like at HIMSS. Hopefully as things return to normal, consumption will stabilize. Still, let’s look out for each other, and if you see one of your colleagues struggling, offer your support.

Fast Company skewered Epic recently over the rollout of the Deterioration Index clinical prediction tool, which is designed to help physicians determine when patients can be moved into or out of higher levels of care. The authors note that the Index was deployed without independent validation or peer review and that physicians cannot see how the raw data is used to calculate the score. There are concerns about the potential for bias in the model based on the underlying data sets upon which it was created. Other worries involve the risks of medical trainees relying too heavily on the index rather than developing their own clinical intuition. The authors call on Epic to release the underlying logic for peer review along with the anonymized data sets used during the internal validation process.

I’d be interested to hear from clinical informaticists whose institutions use the tool. How do you think it’s working, and have you identified any issues? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/17/21

Walmart Provides Digital COVID-19 Vaccine Record

Walmart offers pharmacy customers who receive the COVID-19 vaccine the ability to digitally store their vaccine records via their Walmart.com accounts using technology based on the Vaccination Credential Initiative’s Smart Health Cards standard.

HHS Releases Project US@ Draft Technical Specification Version 1.0 for Comment

ONC releases the Project US@ Draft Technical Specification Version 1.0 for public comment as part of its work to develop a healthcare standard for representing patient addresses.

Ksana Health Secures $2M Seed Round to Launch Advanced Mental Health Monitoring Platform

Behavioral health app startup Ksana Health raises $2 million in seed funding and joins Anthem’s digital incubator.

Stillwater Medical Center Reports Major Computer Outage, Officials Confirm

Stillwater Medical Center (OK) recovers from a computer outage that forced it to cancel appointments and briefly shut down its emergency room.

Morning Headlines 6/16/21

HST Pathways Announces Merger with Clariti Health for Enhanced Patient Price Transparency Resources as Part of its End-to-End Premium Technology Solution

Ambulatory surgery center software vendor HST Pathways acquires patient price transparency vendor Clariti Health.

Tiger Global-backed Bright Health aims for over $14 bln valuation in U.S. IPO

Bright Health, which sells Medicare Advantage insurance in 13 states with claims of technical capabilities, targets its IPO at a $14 billion valuation.

Protenus Raises Series D After Doubling Revenue While Reducing Risk for Health Systems

Healthcare compliance analytics company Protenus raises $21 million in a Series D funding round, bringing its total raised to $57 million.

News 6/16/21

Top News

Ambulatory surgery center software vendor HST Pathways acquires patient price transparency vendor Clariti Health.

Reader Comments

From Forensic Bean Enumerator: “Re: the just-announced $200 million accelerated share repurchase of Allscripts. Remind me again what their PPP loan was and how many employees have been let go of late?” I’m too old school to be an investor today — where stock price is like a baseball card’s “value” in reflecting investor supply and demand rather than company profit, competitive position, and future prospects – but I’ll note that MDRX shares that were at $6 a year ago are now at $18, although longer-term holders haven’t fared nearly as well. I’m also not contemporary enough in my investment knowledge to see share buybacks as having anything to do with the company’s actual business or to link customer happiness with that of stock traders. That’s why Paul Black holds shares worth $30 million and I hold zero shares worth $0, raising the “if you’re so smart, why aren’t you rich” argument.

From End Gamer: “Re: Cerner. The most recent layoffs feel more final than earlier rounds, as long-time leaders in sales and IP have left. The company needed to make some changes post-Neal Patterson, but not this kind. Perhaps you could get some anonymous views from former Cerner leaders about what they see as the company’s best steps and outcomes.” I’m certainly willing to receive anonymous submissions, but I don’t know how much useful insight a former executive would have. Cerner certainly lost its Neal swagger and competitive fire under company man Brent, whose droning “new operating model” mantra resulted in CERN shares rising just 8% from the day he started until the day he announced he was leaving, eating the dust of the boring old Nasdaq index that jumped 92% in the same period. Let’s also not forget that the Cerner board chose Brent, who had never run a publicly traded company, and approved everything he did, showing little backbone in capitulating to an activist investor whose minor share ownership would have generated an appropriately colorful response from Neal. Former executives might have interesting ideas about what Cerner should do strategically, but really the company’s most important decision is choosing its third-ever CEO. As a large, publicly traded company, I would guess they will hire a boring corporate leader, maybe a retread from a different industry who knows how to make the numbers look good. Brent will become Cerner’s John Sculley, the forgotten guy who got Steve Jobs fired and then nearly ran the company into the ground as his dismal CEO replacement before he himself got the axe, although Brent’s problem was doing too little instead of doing actual harm and Neal Patterson won’t be returning to save the day like Steve did. The board made a big mistake in not promoting President Zane Burke to CEO, which seemed obvious even at the time. But to be fair, we cheap-seaters with 20-20 hindsight don’t know what Brent has been dealing with or whether anyone else would have done any better.

HIStalk Announcements and Requests

I’m not a big user of my old Google Assistant and Echo Dot smart speakers, but I wanted to play Spotify playlists at low volume in a couple of rooms where my Sonos speakers aren’t needed. My search was timely since Amazon just opened a sale on the Echo Dot at $50 for two units. The sound and capabilities are decent for a $25 device, although now I have to figure out what else it can do.

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Acquisitions, Funding, Business, and Stock

Private equity firm Berenson Capital acquires Interactive Digital Solutions, a video collaboration and telehealth software vendor known for its MedSitter patient-monitoring technology.

Release-of-information and clinical data interoperability vendor MRO acquires Figmd, a health data aggregation, analytics, and registry company based in Illinois. MRO acquired Cobius Healthcare Solutions, a reimbursement and compliance risk management technology company, earlier this year.

Bright Health, which sells Medicare Advantage insurance in 13 states with claims of technical capabilities, targets its IPO at a $14 billion valuation.

Sales

• Hartford HealthCare (CT) selects Upfront Healthcare’s Care Traffic Control patient engagement and communication software.
• Ozarks Healthcare (MO) will deploy patient e-signature technology from Access.
• Orthopedic Care Physician Network implements Emerge’s ChartScout and uses its EHR data conversion tools as it migrates to Athenahealth.

People

Tim Quigley (Baptist Health Care) joins CloudWave as chief client officer.

Former consultant David Sand, MD joins ZeOmega as chief medical officer.

Nordic names Paul Slaughter (Leidos) EVP of enterprise support services and promotes Ian Mamminga to EVP of managed services.

Behavioral health EHR vendor Kipu names Paul Joiner (Availity) CEO and Rick Pharr (WebPT) COO.

Announcements and Implementations

Healthcare Triangle announces GA of its new CloudEz software-as-a-service, giving organizations the ability to set up their own cloud work environments.

Medcare Hospitals & Medical Centres in the United Arab Emirates has implemented Capsule’s Medical Device Information Platform to connect its medical device ecosystem to its clinical information systems.

Talkdesk announces the launch of Healthcare Experience Cloud for Providers, contact center technology for the enterprise that coordinates and personalizes patient communications.

Beacon Health System (IN) adopts ProviderMatch software from Kyruus to better enable patients to find providers and schedule appointments.

Sponsor Updates

• Agfa HealthCare will present during the virtual UK Imaging & Oncology Congress Online through June 25.
• CarePort will exhibit at ACMA 2021 June 22-25 in Orlando.
• CareSignal shares the assessment of a post-operative opioid stewardship program using its electronic-based automated text and phone messaging platform in which over 80% of patients engaged with more than half of all messages.
• Experian Health VP Karly Rowe will present on SDOH at Reuters Digital Health 2021 June 16.
• The local news covers International Medical Center’s implementation of the InterSystems TrakCare EHR.
• Women’s Health Connecticut connects to the Connecticut Medical Society’s CTHealthLink, part of the Konza Health Network.
• Sectra expands its AI marketplace to include digital pathology apps.
• EClinicalWorks releases a new podcast, “Making the Most of EClinicalWorks Billing and RCM.”

Blog Posts

• How to optimize your clinical data for SNF surveys and PDPM reimbursement (Ability Network)
• Why EHRs Alone Cannot Improve Coordination of Care (Central Logic)
• “I still get flashes of that same excitement as when I was a kid creating my own stuff.” (ConnectiveRx)
• Finding Prescription Affordability Options Amid a Flood of Cards (CoverMyMeds)
• The ‘Last Mile’ in Education and Training (Optimum Healthcare IT)
• Leveraging Data to Reduce Financial Impact from Provider Burnout (Divurgent)
• Epic UGM 2021 Planning Guide: UGM is In-Person (Healthcare IT Leaders)
• An Authoritative Voice for Healthcare Documentation (EClinicalWorks)

Contacts

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

Morning Headlines 6/15/21

Berenson Capital Acquires Interactive Digital Solutions

Private equity firm Berenson Capital acquires Interactive Digital Solutions, a video collaboration and telehealth software vendor known for its MedSitter patient-monitoring technology.

MRO Announces Acquisition of Clinical Data Interoperability Company FIGmd

Release-of-information vendor MRO acquires Figmd, a health data aggregation, analytics, and registry company based in Illinois.

Kipu Announces Strategic Investment from TCV – Appoints Paul Joiner as CEO and Rick Pharr as COO

Behavioral health EHR vendor Kipu names Paul Joiner (Availity) CEO and Rick Pharr (WebPT) COO alongside an unspecified investment from TCV.

Curbside Consult with Dr. Jayne 6/14/21

Today’s post is an interview with Laura Miller, founder and CEO of TempDev of Miami, FL.

Tell me about yourself and the company.

I started TempDev back in 2000. We are primarily a NextGen Healthcare consulting firm, working in practice management and EHR. We tend to be technology driven. I have my degree in computer engineering, we have quite a few engineers on staff, and we have quite a few female engineers. We have development solutions and we also focus on implementation and training as well as project management.

You started as a NextGen application specialist at a physician organization. What gave you the confidence to go out on your own?

I had a good mentor, and a lot of women have that story. I had somebody who encouraged me to do this and also helped me establish myself and my career, who taught me a little bit about consulting. It was a time where I don’t think there were that many people with engineering backgrounds doing development for NextGen clients, and so I think the market was primed for it. As I started exploring, I realized that there was a lot of business opportunity.

I was lucky that on a personal level, I didn’t have a ton of financial obligations. My husband works at Microsoft and we had full benefits. It wasn’t the riskiest of moves, but when I try to tell people that, everyone says, “It still was.” I ended up leaving my full-time job and starting TempDev, and here we are 14 years later.

As an entrepreneur responsible for the livelihoods of others, what kind of thoughts were running through your head as the world began to shut down due to COVID-19?

That was the scariest time I’ve ever had in my career. We have always grown as a company. We had never had to have those difficult thoughts and conversations. We have been incredibly fortunate in our trajectory to never had that enter the picture for us at that level.

As COVID started to happen, at first it was a slam of work. Everybody was implementing telehealth and they didn’t know how to see patients or how to bill it. All these organizations we were working with didn’t even know how they were going to keep their lights on, much less that they were going to spend their money on consultants to try to deliver telehealth, and then let us go.

We were fortunate that there were a couple of companies that kept a lot of our consultants working. It was the first time we had ever had a bench in our entire 14 years. We took the time to say, let’s invest in us. It was the first time we had taken a step back and said, let’s build some things for TempDev. We have some people who aren’t busy. Let’s build some products so that when things come back, and they will come back, we will be ready for them. 

We did. We invested heavily in a couple of products. We invested in COVID testing templates, COVID vaccine templates, and credit balance tools. As things started to come back, it took off and we are busier than ever now.

For the COVID-19 vaccine templates, have you seen a lot of ambulatory practices that have had access to the vaccine or being able to distribute it to their patients?

I’ve actually been pleasantly surprised at who I’ve seen get access to vaccines. It has not been my private practices, the big groups that typically are engaged with consultants. It has been our smaller community health groups and tribal groups. It has been the groups that, as you talk equitable vaccines and you have those conversations, it’s who you want to have these vaccines. It’s who you want to be out there giving them to the community. That was who had the vaccine and who we were talking to in December about vaccinations. A lot of our private clinics didn’t get them until more recently.

Are ambulatory medical practices  starting to rebound?

Most of our clients have rebounded. The investment in FQHC, we’ve definitely been seeing a pickup in that market. They are starting to feel some of the investment that came earlier this year in them and are starting to be able to make improvements they have been wanting to make for a long time. I would say that for most of our groups, their volume is back.

As they are getting back up to speed, what kind of trends are you seeing as they reprioritize their technology goals?

Telehealth is here to stay. Everybody is asking, in what capacity? How are we going to get reimbursed? What does that look like in the future?

As both a patient and a consultant, I love telehealth. I think it’s so wonderful, especially since many of us waste so much time getting to a doctor and sitting in waiting rooms for a five-minute appointment, a checkup, or a talk about a result. It’s so great to be able to have a quick conversation. That needed to happen and a physician can get reimbursed for it, so I think telehealth is here to stay.

TempDev has always been a remote company, so as the pandemic started to unfold, we were well positioned because everybody already worked from home. But for most of our clients, a lot of people aren’t going back to work. Some of the smaller groups tend to be where we see the IT people going back. But a lot of the groups we work with, they’re scaling down on their real estate. If they are talking about maybe getting people back, it is certainly in a much more limited capacity, because I think people got accustomed to working from home and they think it works for a lot of people.

Patients having direct access to their visit notes is a hot topic. Have you seen an increase in requests for help meeting those requirements?

People are still confused by information blocking, especially with the fact that that rule happened during the pandemic. It caught a lot of people off guard. I don’t think they entirely know what it means. I know there were countless webinars. I know people were telling them about it. But I don’t think everybody has grasped what is going to happen there because we don’t get a ton of questions about it other than “Hey, how do I meet this requirement?” which we will walk through with them. We don’t get a lot of questions around, what’s the downstream impact, what if my patient reads this, and should I put this in a note? These are things that you have to think about now that you’ve opened the gate to all of that information. I don’t think people have gotten there yet.

As the only woman in your computer engineering degree classes, what advice do you have for women who are pursuing the STEM fields?

Stay in it.So often we get intimidated, or we often feel like it’s not our place and we don’t belong. I personally never felt like I fit into that culture. It’s not who I am. I love technology, but I do not like a geek culture. I don’t have anything against it. That doesn’t mean that I wasn’t good at math and science or that I couldn’t code, but I didn’t always fit in, and that was OK. I think I brought diversity to something that maybe wasn’t diverse.

Also, a lot of us women just are not showboats. It’s not who we are naturally. That doesn’t mean that we don’t know the information. You also don’t have to have a 4.0 GPA to do well in businesses and to do well in engineering. You can get a B in a class or you can struggle through some engineering classes and that doesn’t mean you’re not cut out for it, it just means that sometimes you might have to work a little harder.

So many cultural things are set up to make us believe that it’s not a place where we belong. I so often just want to tell girls, hey, you belong here. That’s one of the reasons we tend to have a lot of women here, especially for being a tech company. People ask, how did you get all these female engineers and how is your tech team led by all women? It’s because it’s a place where women want to be, because culturally, we fit in here. We didn’t define the culture that a lot of other tech companies have out there. That made something special and something different where people wanted to be and where people wanted to stay, because it is tough.

It’s not the easiest field to be in. In college, they used to tell us things like, you’re going to be up until 3 a.m. in a lab before you’re going to launch a product, and that’s the way life is. I thought, I want a family. I don’t want to be in a lab at 3 a.m. before a product launch, I want to be home in my bed sleeping, and I want to have a life, and I want to have balance. I’m here to tell you that it’s totally fine, and you can have that. It’s not how life has to be. That isn’t necessarily what is presented to you early on in college and in your early career.

You have your children on your team. What advice do you have for young entrepreneurs who are building a company to make sure they have time for family?

You have a limited time with your children because they go off to college. You get 18 years with them, hopefully. Or they’re at home and you don’t want to waste it. I have made it a rule to pretty much to stop work from 5:00 to 8:00 each evening. I have my phone on me, so if something blows up, I will get on it, but things can wait. You can’t work your entire life. Your children are good at making you understand what your priorities are and keeping them in check. From 5:00 to 8:00 every day is my kids’ time. Then I put them to bed and I will probably go back on my email and I will probably finish up my workday. But I make sure I always have time for them. I make sure they know that they are number one and everything else is number two.

That doesn’t mean I won’t go out of town or that I don’t sometimes treat work with a high priority that needs to be, but it can never be above my kids. That’s who I am and that drives me. I’ve never run into a problem with it. So many times we as women are set up to believe that there’s something wrong with that and there isn’t. Going back to work from home culture, I can run out and get my kid who is sick from school and bring them home. They can lay in their bed and be sick from school and nobody at work is judging me. They don’t even know I’m gone, and they don’t even know my kid’s home sick. That’s something so nice about being able to be a mom and being able to balance your work.

Do you have any final thoughts?

If you’re not working in a place that makes you happy, build a place that makes you happy. Try to do the right thing at that place and make whatever decisions are needed to build a place where people want to be, where women or employees feel valued and feel like they can put their families first, feel like they can take care of clients and still have time, and still have work-life balance. Build that as a company because you can’t run down your employees. Your employees are your number one asset. If you ever ask me the hardest part of my job, it’s recruiting and finding employees to fill the positions we have. Losing an employee is even harder for us. Make sure to respect that and build a place where employees want to be, and always have that as your guiding light.Make sure it’s a place where all employees want to be and not just a certain subset.

Morning Headlines 6/14/21

Chief Operating Officer of Network Security Company Charged with Cyberattack on Medical Center

A federal court indicts the COO of Atlanta-area Internet of Things security vendor Securolytics, claiming that he launched a 2018 cyberattack against Gwinnett Medical Center (now Northside Hospital Gwinnett) for personal financial gain.

Joint DOD-VA Medical Center Will Be Major Test for Electronic Health Record Interoperability

Captain James A. Lovell Federal Health Care Center (IL), a joint facility used by both the VA and DoD, will be the first test of interoperability between their respective Cerner implementations.

Mount Sinai Health System Launches Elementa Labs, A Virtual Incubator Program

Mount Sinai Innovation Partners has launched a virtual incubator program to help health IT and biotechnology startups develop their products leveraging Mount Sinai Health System’s resources and expertise.

Monday Morning Update 6/14/21

Top News

A federal court indicts the COO of Atlanta-area Internet of Things security vendor Securolytics, claiming that he launched a 2018 cyberattack against Gwinnett Medical Center (now Northside Hospital Gwinnett) for personal financial gain.

Vikas Singla allegedly disrupted the hospital’s phone service, obtained information from a digitizing device, and disrupted network printing for unspecified purposes.

Singla pleaded not guilty to 18 charges, was released on $20,000 bond, and will return to court June 23.

HIStalk Announcements and Requests

Poll respondents are nearly universally in favor of implementing a national patient identifier, with the majority of those believing that its use should be mandatory.

New poll to your right or here, as suggested by a reader: Looking back five years, which aspects of healthcare have been significantly improved by technology?

Reminder: I’ll include HIStalk sponsors who are exhibiting at and/or attending HIMSS21 in my HIMSS guide if you submit your details. Meanwhile, It’s not even summer yet and Las Vegas will have daily highs in the 117-degree range for most of this week, to the point that motivational speakers could convene one of their BS firewalking rituals by just having participants take their shoes off and walk 20 feet on a Strip sidewalk.

It feels as though the industry is taking an actual summer break, as opposed to the never-ending virtual connections of 2020, given the absence of significant news over the weekend. Shockingly, I saw no new announcements of money-losing companies that I’ve never heard of being valued at billions of dollars, no eye-rollingly fawning articles describing how AI will disrupt healthcare, or non-experts seeking attention by claiming that Cerner or Meditech or some other company might be acquired by someone someday. It may be that everybody is saving their energy for HIMSS21, but I suspect that isn’t the case and instead we’re just enjoying a return to pre-pandemic summer life. At any rate, enjoy today’s minimal reading time since I have no incentive to dishonestly pad things out just to hold your attention.

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Sales

• SouthEast Alaska Regional Health Consortium goes live on Nuance Dragon Ambient Experience.

Announcements and Implementations

California will implement an electronic vaccination verification system “very shortly.” The state emphasizes that the unspecified system is not a vaccine passport because it will be offered only to private businesses who can decide for themselves how to use it, if at all.

Government and Politics

Captain James A. Lovell Federal Health Care Center (IL), a joint facility used by both the VA and DoD, will be the first test of interoperability between their respective Cerner implementations.

Sponsor Updates

• Waystar partners with career development nonprofit Inroads to launch a health IT internship program for local students.
• Healthwise has received seven Digital Health Awards for its patient education videos and content in the Health Information Resource Center’s 2021 spring competition.
• Netsmart VP & GM of CareGuidance AJ Peterson is included in the Kansas City Business Journal’s list of 2021 NextGen Leaders.
• Protenus publishes a new report, “2021 Diversion Digest: COVID-19 Conceals True Scope of Clinical Drug Diversion in 2020 as Incidents Left Undiscovered.”
• Talkdesk names Laura Butler (Workfront) chief human resources officer.
• Tegria publishes a new white paper, “Cloud-Based Managed Services Allow Healthcare Organizations to Do What They Do Best: Focus on Patient Care.”

Blog Posts

• Worrying About Being Sued – A Call to Action (Nuance)
• Polishing your portal to empower patients (Nordic)
• How Wearable Technologies are Creating New Clinical Trial Endpoints (PatientBond)
• Billions of $ in Funding for Public Health: 3 Strategies to Make the Most of It (Pivot Point Consulting)
• How Cyber Insurance Fits Into Your Cyber Security Posture (Fortified Health Security)
• How Can We Make Healthcare Billing Easier for Nephrologists? (PMD)
• How Updated Star Ratings Impact Your Hospital (Premier)
• 4 Ways to Improve Your Patient Communication Outreach (Twistle)
• Stretched to Their Limit, Doctors and Nurses Account for 67% of Drug Diversion in 2020 (Protenus)
• A Tale of Two Ransomware Attacks: Which Company Are You? (Pure Storage)
• How to Use HCC Analytics to Improve Provider Education and Point-of-Care HCC Capture (RCxRules)
• 6 Ways to Influence HCAHPS with Interactive Technology (Sonifi Health)
• PCI Data Discovery Tools: Is Your Organization Protecting Its Data? (Spirion)
• 6 things to know when purchasing on-call scheduling software (Spok)
• Enhancing the member experience with help plan fulfillment services (Krames)
• What is customer experience and why it matters in your contact center (Talkdesk)
• How Video Conferencing is Improving Patient and Family Communication (Vocera)
• 4 steps to getting the most out of your analytics (Waystar)
• 3 Reasons to Adopt a Team Treatment Systems in Your PT Clinic (WebPT)
• Are Self-Signed Certificates Hiding in Your Interface Engine? (Zen Healthcare IT)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Weekender 6/11/21

Weekly News Recap

• Iodine Software acquires ChartWise Medical Systems.
• Cerner eliminates 500 positions.
• Amazon announces significant growth and external customer interest in its Amazon Care telehealth service.
• Ciox Health announces its intent to merge with Datavant in a deal valued at $7 billion.
• Definitive Healthcare, which acquired HIMSS Analytics in 2019, prepares to go public.
• RCM vendor Craneware enters an agreement to acquire pharmacy software vendor Sentry Data Systems.
• SAIC announces plans to acquire government health IT contractor Halfaker and Associates.
• UF Health Central Florida’s two hospitals go back to paper following a May 31 ransomware attack.

Best Reader Comments

With all of this money being poured into startups by VCs and PE and everyone promising a better widget to do X, how would patients (or consumers of health care) respond if they were to be asked this (Reagan) question – “Are you better off today than you were four years ago?” Is care more accessible? Valuable? Equitable? Cheaper? Safer? (Ghost of Andromeda)

I do worry about the monetization of the healthcare and the drive for young practitioners to get the best specialty. Some, I am sure are just drawn to that specialty, others are drawn to the compensation. The monetization goes up and down the stack, from VCs purchasing rural hospitals so they can overcharge for labs, to purchasers of EHRs so they can overcharge the clinics, to hospital administrators who have forgotten that a hospital is for patient care, not for generating an insurance bill or funding a collections company. (J Brody Brodock)

From a medical output standpoint, the most productive primary care practices probably have less than five providers. Technology provides little to no benefit. Practices get larger so that they can negotiate with insurance. The dynamics are different for single and multi speciality and hospital owned of course. We shouldn’t raise the compensation for primary care. We shouldn’t raise the compensation for anyone in medicine. We should lower barriers so that there is more competition. (IANAL)

One of the truisms I was told a long time ago by family medicine founding fathers is that primary care has always failed to compete adequately in the American way of doing things. Our commitment to patient care — our mensch-like attitudes to do good on local scales one case at a time, coupled with our lower incomes has kept primary care physicians from putting the same amount of money and time resources into changing the system as our specialist colleagues. That has only been exacerbated by the lobbying dollars of the pharmaceutical and insurance firms along with the large organized health care industry in general to take advantage of primary care physicians as malleable, low-cost solutions. Bluntly put, while we are doing our quarterly CME questions for our 2.5 points, thereby allowing our leaders to justify their latest layer of obfuscation without real change, we could have been communicating and networking with others. (Kevin Hepler)

If we are being completely honest, it’s about, how do we make the field of medicine more attractive to clinicians? And all of that adds up to going back in time. Society has already chosen, and mostly, society doesn’t care. (Brian Too)

Bold of Ascension to so immediately follow Baylor Scott & White, without even waiting to pick up some lessons learned. The latter has, at the most generous, an extremely bumpy year ahead as it tries to recover from its continuing hemorrhage of experienced Epic employees (retained and outsourced alike) and astonishing lack of due diligence (as admitted by its leadership). I suppose if more organizations outsource, analysts will be more persuadable that this is the way of the future instead of temporary insanity and attempt to stick it out. Can’t we just have nice things? (formerly BSW)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Kentucky, who asked for an inspiration board for her kindergarten class. She reports, “Thank you for your generous donation to this project. Our Royal Imagination Station is so helpful for easy access and viewing from anywhere in our classroom. It is so handy to move the board throughout our classroom, so that every learner can easily see the display. My learners use it daily for creating anchor charts, practicing letter writing, phonemic awareness for letters and sounds, and reviewing previous learning materials (as a reference tool). We will enjoy this useful tool for many years to come.“

Dartmouth’s medical school apologizes and drops its threats of expulsion against 17 students who it had claimed cheated on an online exam by looking up answers. The university secretly monitored the use of its learning management system by test-takers by reviewing its activity log after the fact, but the Canvas tool was not designed for that purpose and a New York Times review found that the software’s automated background activity can mimic user interaction.

In the UK, a liver surgeon who was suspended in 2017 for using a surgical laser to burn his autograph into patient organs is allowed to practice again.

MIT Technology Review takes a look at the vaccine waitlist site Dr. B, which collected 2.5 million signups from people who hoped to be matched to leftover vaccine doses. The site, which was founded by Zocdoc founder and former CEO Cyrus Massoumi, refuses to say whether anyone actually found vaccine after signing up and how their data will be used or sold (the site is not a covered entity, so users enjoy no HIPAA protections). The site had agreements with just two vaccination sites in the entire US when it went on a PR blitz in March, but accepted signups nationally. Meanwhile, Dr. B has at least 56 employees, many of which have a background in politics, and it has acquired similar services. Massoumi unsuccessfully sued Zocdoc last year claiming that he was ousted by his conspiring co-founders in 2015. UPDATE: the company provided this response:

Dr. B was launched at the height of the COVID crisis to get vaccines into as many arms as possible and we have saved lives through this effort. While we have already sent more than 1.1 million notifications to users about available vaccines, we don’t track when shots have been received. User privacy is our top priority and Dr. B never rents or sells user data. At any time, users can also ask to stop receiving notifications and also completely purge their data from Dr. B.

The New York Post says that insurer Clover Health has become a “meme stock” whose share price swings wildly based on the whims of Reddit “WallStreetBets” traders, also noting that the company’s two co-founders – who became billionaires when Clover Health went public via a SPAC — bought three non-profit New Jersey hospitals and converted them to for-profit CarePoint, with one of them earning the distinction as the most expensive hospital in America. The hospitals, which dropped insurance contracts so they could bill ED visits at out-of-network rates, charged one teacher $9,000 to apply a bandage to her cut that required no stitches. Day-trading Redditers got interested in Clover Health shares when a short-selling analyst claimed that the company is inflating sales.

An anti-vaccine doctor and nurse who were brought to an Ohio health committee meeting as expert witnesses who oppose business or the government requiring COVID-19 vaccination argue that not only have COVID-19 shots killed 5,000 people, they also magnetize recipients. The nurse dramatically proclaimed to state legislators, “Explain to me why the key sticks to me,” sticking with her script even as the key failed repeatedly to stick to her neck. Both healthcare professionals cited as their information source “pictures all over the Internet.”

Sentara Albemarle Medical Center (NC) celebrates its longest-tenured employee, 82-year-old Willie Mae Overton, who started working at the hospital in 1961.

A military publication profiles 30-year-old Nevada Air Guard 1st Lt. Caleena Longworth, MD, whose youthful appearance and spring graduation from medical school earned her the nickname “Baby Doc.” She completed medical school in working around her COVID-19 deployment, where she was involved with testing and vaccination. 

In Case You Missed It

• News 6/11/21
• EPtalk by Dr. Jayne 6/10/21
• News 6/9/21
• Curbside Consult with Dr. Jayne 6/7/21
• HIStalk Interviews Richard Caplin, CEO, The HCI Group
• Book Review: “Big Med”
• Monday Morning Update 6/7/21

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