Curbside Consult with Dr. Jayne 10/24/22

I’ve used a GPS watch to track my hikes and other travels for almost a decade. Recently, some of the features on my trusty Garmin Forerunner 25 have become erratic and had me looking for an upgrade. I’ve had it for seven years and it has served me well, but I was annoyed after the GPS went rogue a couple of times and the sleep tracker started showing the same pattern whether the watch was on my wrist or on the bathroom counter.

After extensive troubleshooting with Garmin, they couldn’t come up with a remedy and offered me a discount, but only if I stayed within the Forerunner line. I wasn’t thrilled with the options and had been casually looking at other models when a friend clued me in to a sale, spurring me to make a decision.

Wearables hold an interesting place in the hearts and minds of patients. I have plenty of friends that are obsessed with “closing the ring” on their Apple watches to the point where they are almost a servant to the technology. I’ve taken care of patients who take their daily activity tracking data seriously, to the point of messaging their physicians asking about what the slightest blip in their numbers might mean.

I’m not training for half marathons anymore, so I don’t need a lot of the training or coaching features that are out there. I wanted something with decent battery life, both as a watch and in GPS mode, as well as something that looks a little more stylish and a lot less rubbery than my current device. I settled on a watch from the Garmin Venu line.

Garmin’s packaging has become more streamlined since my last purchase. However, the setup process was considerably more complicated. Although I already had the Garmin Connect app on my phone, I couldn’t get it to pair with the watch and had to update the app. It still didn’t work, so I thought I would set up the watch manually then try the Bluetooth piece later.

Garmin is apparently confused about sex versus gender and how biological sex is more aligned with physiologic parameters than gender and only gave a choice of two genders. I picked the stereotypical pink icon with the ponytail, but hope someone at Garmin gets educated about the difference between sex and gender.

The next step was trying to set the watch via the GPS, which didn’t work. I’m assuming the GPS wasn’t working well inside my house, but since you’re supposed to have the device plugged in with the USB cable and charging while you do this, I was just following the directions. I’m not sure how many people have USB ports in their driveways.

I also ran across the menstrual tracking option on the device, which I promptly turned off. Most people don’t realize that HIPAA does not protect this kind of data when it’s being sent to an organization that is not a HIPAA-covered entity, and especially given the political climate, I have no plans to share that via a wearable.

During this process, the watch fell on the floor no less than three times due to the short USB cord that was connected to my floor-dwelling PC, coupled with the fact that it hooks perpendicularly into the back of the watch, making it unable to be placed flat on a surface.

The next step was to apply a system update to my phone, which for some reason took several hours. I tried several more times to get it to connect without any luck. Ultimately, I used Garmin Express to connect it directly to the PC, after which it forced a firmware upgrade to the watch. I was hopeful that would do the trick, but it didn’t. However, while the watch was connected to the PC, I was able to connect it to my wifi network, so at least that was something.

After disconnecting the watch, I had to take care of some household tasks and noticed that the watch wasn’t counting steps. It was counting heart rate and respirations, which I find less useful, and not doing the one task that was most important to me. After lots of fussing about with the menus, I tried a system setting to see what version the firmware was on, and it said that an update was needed. I tried to connect it back to the PC, but it wouldn’t pick up, and after plugging it in and unplugging it way too many times, it finally connected and the Garmin Express software showed that despite the recent status of “update complete,” three more updates were now needed.

Each time an update completed, I had to do a manual sync to get the next update to register, and also restart the watch. Meanwhile, Garmin Express kept telling me that the watch wasn’t connected, while the watch showed that it was.

I was asked no less than three times during the process to set up wifi and went through the entire process to have no change in the user experience. I went back to the main Garmin Express menu and was now told that I had 37 updates available even though the previous screen had said, “You’re up to date!” There is nothing worse than a confusing user interface that doesn’t tell you what’s going on or what you really need to do.

After two more unplug-and-restart cycles, the update counter disappeared and and miraculously, over 4,000 steps appeared on my watch. There’s no way they’re legitimate considering I was only wearing the watch for a couple of trips to the laundry room and back. After some digging, I figured out that somehow the steps on my old watch had been ported onto the new watch, which was definitely unexpected.

Fast forward to nearly a week worth of intermittent attempts to connect via Bluetooth. I gave up on it. I can pair the watch to someone else’s phone and pair my phone to other devices, but can’t pair the watch to my own phone. Without the Bluetooth, you lose out on several valuable features – music, alert notification for falls or incidents, and a couple of other things. I’m still able to sync the watch with my PC like I was the previous model. I hadn’t planned to allow it to display text messages or emails, so I resigned myself to being a little retro with my connectivity. I’m hypothesizing that the battery life will be much better without the connection, but I’ll know for sure in a few more days.

It’s snazzier than my previous device. I like its subtle coloring and low profile versus the chunky black model I’ve been wearing for years. For the first couple of days, the synthetic material watch band had a particular smell to it, which probably wouldn’t mean much to the average person, but to me smelled like an operating room. Although it brought back some fond memories, I was glad when it dissipated.

Overall, I’ll give this particular Garmin a solid B. It’s better than my last one, but not as great as it could be. The price was right.

What’s your favorite wearable, and how do you like (or dislike) its features? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Applying AI to Improve Patient Care

Applying AI to Improve Patient Care
By Tomas Gogar

Tomas Gogar, MS is co-founder and CEO of Rossum of London, England.

Despite the technological advancements in healthcare over the past decade, the administration and quality of patient care has not kept pace. The industry is faced with the realization that if technological changes aren’t implemented at a foundational level, providers, payers, and patients won’t be able to realize the full value of the technology available to them.

The majority of medical institutions rely on electronic health records (EHR) to input, read, and upload critical documents related to patient care into online portals. The EHR concept, introduced in the 1960s, while valuable to the healthcare community, has yet to eliminate the need for manual paperwork. Paperwork is a huge drain and cost, taking time, energy, and precise attention to detail to ensure that all documents are properly scanned into the correct patient files.

Missing information can lead to delays in care, misdiagnosis, miscommunication around treatment plans, and the duplication of costly tests and procedures. Relying strictly on manual processes to manage such large amounts of information can be administratively crippling to a healthcare organization. The World Health Organization estimates that up to 50% of all medical documentation mistakes result from administrative errors.

By integrating intelligent document processing (IDP) into the systems, hospitals and healthcare institutions save time, reduce operational costs, and improve workflows. Introducing an IDP system into the EHR workflow means medical professionals across departments can easily scan and upload documentation into a secure SOC 2 and HIPAA compliant operating system. IDP efficiently captures, categorizes, extracts, and classifies data from documents, streamlining the workflow process and reducing the paperwork necessary for a patient file.

IDP also helps sustain HIPAA compliance, which can be challenging when dealing with thousands of physical documents stored in different formats and locations across a health system. Accounting for small margins for human error causes long input times and exhaustive efforts to safeguard physical documents containing patient information. With the implementation of IDP, this process eliminates any chance of human error in handling sensitive information and allows for patient data to be processed quickly, safely, and securely.

From a patient perspective, automating and streamlining document processing enables providers to get complete, accurate data straight into a patient’s hands via online portals. From the healthcare organization side, IDP can reduce document burnout that healthcare professionals are prone to experiencing.

For hospitals struggling with overhead operational costs, implementing IDP is a lucrative resource. By using IDP to process documents like prescription referrals, lab records, billing, and claims forms, manual data entry is drastically reduced, thereby reducing the need for resources associated with data entry into EHR and patient portals and enabling the healthcare organization to re-allocate them to more strategic tasks. In addition to labor costs, implementing IDP reduces costs associated with paper storage, security measures in place to store these documents, and any costs associated with administrative errors.

During a time when all our hospitals are critically understaffed and underfunded, ensuring that every worker is given the necessary tools and resources to adequately and efficiently perform their jobs is more crucial than ever.

Readers Write: Thinking Differently About OR Block Time

Thinking Differently About OR Block Time
By Michael Burke

Michael Burke, MBA is founder and CEO of Copient Health of Atlanta, GA.

The operating room is the hospital’s largest source of earnings, as well as the largest hospital cost category. Most OR time is allocated in advance to surgeons in chunks of time called blocks. Surgeons schedule cases into their allocated block time, such as Tuesdays from 7 a.m. to 3 p.m.

Block time often goes unfilled due to poor allocation decisions, case volume that can vary meaningfully from week to week, and surgeons neglecting to release block time when traveling or otherwise unavailable to use it. Often, OR time that sits empty can be filled with elective cases that have an average contribution margin of $2,000 per OR hour. Instead, the fixed costs from unused OR hours add up with no revenue to offset them.

Identifying block time that would otherwise go unfilled, getting it released, then refilling the time is something hospitals have attempted to do for quite a while. The process has been largely manual and has missed a meaningful portion of the opportunity, as evidenced by block utilization statistics.

New tools use machine learning to predict block time that is likely to go unfilled, along with mechanisms for seeking the release of the identified time and requesting the time. Finding more time, getting it released earlier, and getting it into the hands of those who can use it are all excellent reasons for adopting such a solution. Hospitals can make real gains with this approach. The core of the strategy is that any block time that would otherwise go unfilled should be filled with positive contribution margin cases whenever possible.

Surgeons are hesitant to release block time allocated to them, even if they don’t have cases to fill it. In most compensation scenarios, a surgeon has a financial incentive to hold on to any OR time allocated to them in the event that a case might come along later. Even if they are an equity holder in an ASC and benefit from facility earnings shared as dividends, they are still subject to a form of the prisoner’s dilemma. This affects their decision-making and can bias them against releasing allocated block time for which they don’t have cases to fill. Although some portion of unused time is collected from surgeons by proactive nudge reminders and the ad hoc efforts of the scheduling team, diverging incentives unnecessarily limit the amount of time that can be recaptured and repurposed.

In many ways, the math behind the predictions is the easy part. The difficulty lies in aligning incentives and driving changes in behavior. The structure of your incentives and your willingness to push will have as much or more impact on the success of an OR optimization effort as the predictive software you select. Maybe we should also consider taking lessons from other industries dealing with similar scarce resource challenges.

What if we thought of a hospital as an airline and an OR block day as a flight? Travelers or travel agents (schedulers) book seats on the plane (cases in the OR). However, from its predictive analytics, the airline knows that some seats will go unfilled, even if booked to capacity. The OR block appears to be booked to capacity in much the same way  since 100% of the block’s time is allocated to the block holder.

But we know the block holder won’t fill all the allocated time, just like the airline knows that without intervention, many more seats on the plane would go empty due to no-shows or missed connections. The airline uses predictive analytics to intentionally and confidently overbook the flight to account for this.

The hospital should consider a similar process because the block holder often won’t fill an entire block with cases. To be clear, you wouldn’t be overbooking, since the chunks of time into which you would book cases are empty and predicted to remain so. The math behind the predictions for an OR is different from that of an airline flight, but the analogy still applies. By adopting this strategy, hospitals could fill much more time in their OR blocks with a high degree of certainty that the block holder won’t need it. This approach bypasses the behavioral challenge of seeking permission from the block holder early enough for the unneeded time to be usable, resulting in more recaptured OR time and more contribution margin.

Morning Headlines 10/24/22

Lawsuit accuses medical tech company Masimo of creating an Apple Watch clone

Apple sues medical technology company Masimo, claiming that it cloned the Apple Watch for its W1 Advanced Health Tracking Watch.

Oracle CloudWorld 2022: Ellison Says An ‘Internet Of Clouds’ Is Imperative

Oracle co-founder and CTO Larry Ellison tells CloudWorld 2022 attendees that the company will partner with other companies to build next-generation healthcare applications, saying that “there’s no way we can do this by ourselves.”

Antidote axes a third of its employees

Antidote Health, an Israeli company that markets its telemedicine service to consumers in the US, will reportedly lay off 23 local employees.

Henry Ford Health’s Specialty Pharmacy Software Goes National

Henry Ford Health commercializes its internally developed DromosPTM patient therapy management solution for specialty pharmacies.

Monday Morning Update 10/24/22

Top News

Oracle co-founder and CTO Larry Ellison tells CloudWorld 2022 attendees that the company will partner with other companies to build next-generation healthcare applications, saying that “there’s no way we can do this by ourselves.”

Ellison again touted creation of a national health records database, warning that healthcare costs will bankrupt Western civilization unless efficiency is improved,

He added that acquiring Cerner was “maybe the single most important thing we did in terms of expanding our own capacity.”  

Reader Comments

From Jostler: “Re: tokenization. Any experts out there you could interview, or any summaries of how it is actually being used? I can’t tell if it’s hype or if it will be useful to get more data.” Tokenization is a way to link several data sets together so that a patient can be viewed as an individual via an encrypted token. The underlying data remains de-identified. A researcher would be able to tell that a given oncology clinic patient also picked up prescriptions at Walgreens and visited two health system EDs, for example, but would not be privy to that patient’s private information. I would be interested in hearing from people who have tokenization expertise or who have used it for research.

HIStalk Announcements and Requests

Poll respondents who could move anywhere would most often consider the new area’s proximity to family, weather, and social and political environment. Interesting, few respondents care much about access to high quality health services, perhaps not yet having attained the age in which quality and quantity of life might depend on the services available in your location’s medical golden hour. Some respondents say that proximity to an airport that is an airline’s major hub would have ranked high on their list.

New poll to your right or here, extending Dr. Jayne’s experience where the front desk person insisted she didn’t owe the co-pay that was clearly listed on her insurance card. In your most recent ambulatory medical encounter in which you owed a co-pay, was it collected before you left?

Webinars

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

People

Jamey Pennington (Coker Group) joins Southwell as VP and chief information and HIPAA security officer.

CoverMyMeds promotes Lindsay Miller to VP of account operations.

Announcements and Implementations

Henry Ford Health commercializes its internally developed DromosPTM patient therapy management solution for specialty pharmacies.

Government and Politics

A Florida man pleads guilty to conspiracy and kickback charges for running an Internet-based platform on which physician orders for back and knee braces were bought and sold, yielding him a cut of the transactions. Nagainda Srivastav also ran call centers to find beneficiaries who could be billed for DME, then bought physician orders from offshore telemedicine companies that he sold online. His scheme generated at least $25 million in federal healthcare payments. His B2B Apps Solutions sells cloud-based pharmacy and EHR apps. Basic Googling turns up his $2.4 million, 8,900-square-foot  waterfront home in Tampa.

Apple sues medical technology company Masimo, claiming that it cloned the Apple Watch for its W1 Advanced Health Tracking Watch. Masimo previously accused Apple of contacting it in 2013 about potential collaboration, then using the meeting to identify Masimo employees it could poach, including its chief medical officer and those knowledgeable about pulse oximetry sensors, which Masimo says it invented.

Privacy and Security

Sen. Mark Warner (D-VA) sends a letter to Meta CEO Mark Zuckerberg, asking him to explain how its Meta Pixel tracker collects, stores, and uses the information of website visitors. He also wants to know what steps have been taken since The Markup publicized Meta Pixel’s use by health systems and how the system filters sensitive health information.

Other

A New York Times article on preparing for surgery suggests using Abridge, an app that records doctor-patient conversations and shares the recording and transcription with both. Co-founder and CEO Shiv Rao is a UMPC cardiologist and spent time as EVP of UPMC Enterprises.

The San Diego sheriff’s department will monitor its most medically vulnerable incarcerees using tamper-proof biosensor trackers, hoping to reduce in-custody deaths. The $1,000 ankle-attached trackers will be provided by 4Sight Labs, which a Colorado police department credits with saving the lives of three people who were in custody.

Sponsor Updates

• OptimizeRx and Melinta Therapeutics will present Innovate4Outcomes, a virtual event that will focus on antimicrobial resistance,  on December 1.
• Sphere will exhibit at Athenahealth’s Thrive conference October 24-26 in Austin, TX.
• Volpara Health achieves B Corp. Certification.
• Wolters Kluwer Health publishes a new e-book, “Transforming the Nursing Workforce: Keys to Delivering Health Equity and Fostering Resilience.”
• Verato will exhibit at APHSA ISM 2022 October 23-26 in National Harbor, MD.

Blog Posts

• How Riverside Health System is Redefining Their HCC Coding Initiatives (Premier)
• How Center for Primary Care Improved their HCC Coding Without Hiring Additional Staff (RCxRules)
• 7 Tips to Address Medical Practice Burnout (Relatient)
• 11 tools for employing at-home call center agents (Talkdesk)
• Ready for HR Modernization? Score Big with these Five Early Wins (Optimum Healthcare IT)
• Improving Critical Care Workflows at CommonSpirit (TigerConnect)
• A broad definition of healthcare workplace violence leads to better caregiver safety (Vocera)
• Are You Going to PPS 2022? Come See Us! (WebPT)
• Crisis response leads to promising new care delivery models (Wolters Kluwer Health)

Contacts

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

Morning Headlines 10/21/22

Health system data breach due to Meta Pixel hits 3 million patients

Advocate Aurora Health joins other large health systems in notifying millions of patients that their information was potentially exposed via the Meta Pixel website user tracker.

CitiusTech Announces Investment and Strategic Partnership from Bain Capital Private Equity

Digital health technology and consulting company CitiusTech secures an undisclosed amount of funding from Bain Capital.

Connective Health Announces the Completion of its Seed Funding Round

Connective Health, a Boston-based clinical summary and predictive insights startup, wraps up its seed funding round with financing led by Activate Venture Partners.

News 10/21/22

Top News

Advocate Aurora Health joins other large health systems in notifying millions of patients that their information was potentially exposed via the Meta Pixel website user tracker.

AAH says it is notifying all of its 3 million patients that it had installed the tracker on its MyChart and LiveWell patient portals, which gave Facebook advertisers access to their IP address, appointment details, providers, type of appointment, MyChart messages, and insurance information.

AAH says it installed the pixel to evaluate how consumers use its websites, but was not aware of the extent of information that was being collected and sent to third parties. It has removed the tracking tool.

Reader Comments

From Garbanzo: “Re: Unite Us. They may be the SDOH platform giant in terms of business, but not in KLAS reports.” Click to enlarge the graphic above that was sent by this reader, which compares competitors Findhelp and Unite Us in the categories of culture, loyalty, operations, product, relationship, and value.

From Isthmus: “Re: NH SB 423. The privacy bill was actually supported by Unite Us, voting was unanimous, and the Unite Us contract was placed in moratorium and then ended because it didn’t meet state privacy rules. Testimony is here.”

Webinars

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

Here’s the recording of this week’s webinar, sponsored by Mend, titled “Patient Payment Trends 2022 Learn All The Secrets.”

Announcements and Implementations

Trilliant Health’s excellent annual health economy report makes these points (I interviewed SVP / Chief Research Officer Sanjula Jain, PhD a few months ago):

• The number of commercially insured Americans, who drive most of healthcare’s profits, is declining, and the Medicare-eligible population is growing faster than other cohorts.
• Cancer screening volume is down, making it likely that initial diagnoses will be made in more advanced stages.
• Behavioral health and related medication prescribing are up significantly, but vary by market.
• Hospital inpatient and outpatient volumes have been flat for years even as obesity and chronic disease increases. Digestive surgeries will have the highest growth in almost all markets.
• Telehealth utilization remains high, but is being used significantly less that at its peak by seniors and children and is broadly shifting back to mostly in-person care. Most patients who have used telehealth have done so only once, and the biggest use is for behavioral health. Oversupply will cause telehealth visit prices to keep dropping, possibly to $0 if commercial insurers offer them at no cost.
• Medicare and Medicaid spending and projected increases are unsustainable and Americans have accumulated $140 billion in medical debt.
• Services are rapidly shifting to ambulatory settings. 
• The report observes that “only in healthcare can a monopoly lose money” as even market-controlling hospitals generate negative margins. It also notes that “the paradox of declining demand and rising price defies the laws of economics” as US healthcare prices keep rising as outcomes such as life expectancy keep falling. 

A study finds that use of AI-powered wound imaging and analysis software from Net Health allowed a virtual wound care program to provide quicker access and improved management to remote patients who took photos of their own wounds for specialist review.

LexisNexis Risk Solutions launches MarketView Patient Journey Intelligence, which uses tokenization technology to link de-identified datasets to analyze a patient’s movement through the care continuum.

An AHIMA white paper urges health information professionals to take on roles related to analytics, managing social determinants of health, helping clinicians use EHR information to engage patients, working with the design and management of online tools for value-based care, supporting efforts to roll out digital front doors, and developing AI processes. Interviewees differed on whether health information professionals will work more directly with patients.

Meditech launches Expanse Population Insight, which uses claims and EHR data from the Innovaccer Data Platform to provide information about risk, care gaps, and utilization at the point of care.

The joint venture health plan owned by Banner Health and Aetna/CVS Health rolls out “frictionless billing,” which shows patients what the provider billed, what insurance covered, and what they personally owe so they can pay their balance.

Government and Politics

FDA warns that amphetamine-based ADHD drug Adderall is in short supply. Experts question whether the shortage may have been exacerbated by online startups that marketed their prescribing of the drug via virtual virtual encounters that were convenient, inexpensive, and sometimes short on sound medical practice.

Privacy and Security

Analysis by data privacy firm Lokker finds that of 5,000 websites of hospitals and healthcare services providers, 40% use trackers from Facebook, 13% from Microsoft, 8% from Twitter, 6% from Pinterest, and 5% of TikTok. The company says that the web browser is the new endpoint to defend, containing privacy risks such as malware, PHI data skimming, and data broker fingerprinting scripts that repeatedly enrich user profiles to the point they can identify a specific website visitor.

A hacker breaches Australia’s insurer, Medibank, and steals 200 gigabytes of data that includes customer medical procedures, diagnoses, addresses, and credit card details.  A hacker group told the company it was interested in negotiating the disposition of the information it took.

Other

The Atlantic says that COVID-19 datasets are no longer reliable for predictive purposes due to (a) uncounted home test results; (b) CDC and stage agencies moving to weekly instead of daily reporting; and (c) and some states ending their reporting entirely. It says that hospital-reported data is sound, but it lags cases and doesn’t necessarily reflect transmission rates. Wastewater surveillance is consistent and free of biases for trend analysis. The authors also recommend conducting local population surveys to understand how many people are testing positive and what demographic groups they are in.

A medical building’s janitor is charged with felony aggravated assault with a deadly weapon when a co-worker’s hidden camera captures him urinating into the water bottle she had left on her desk. The woman, who was trying to figure out why her water always tasted and looked funny, says that she caught herpes from the contact. Eleven of her co-workers have come forward with similar complaints. The janitor admitted to police that he had repeatedly peed into employee water bottles and the building’s five-gallon dispenser and admits to doing the same thing at other buildings where he was assigned by his janitorial services employer.

A woman who visited the ED of John Muir Medical Center fearing fentanyl poisoning sues the health system for for billing her $6,100 for a drug screening test for which it accepts a $62 payment from Medicare. The woman says the ED wouldn’t see her until she signed a contract that required her to pay “regular rates and terms” and didn’t run the urine screen until after her three-hour visit, for which the health system wants her to pay $7,100 on top of the $6,000 that insurance has already paid.

Sponsor Updates

• Netsmart sponsors MHMR Tarrant’s 15th Annual Opening Doors Dinner to raise money for specialized therapies, transitional living, and peer support programs in the Fort Worth, TX area.
• Healthcare Triangle publishes a new whitepaper, “Moving Your Healthcare Digital Strategy from Theory to Execution: CHIME’22 Survey Reveals 3 Insights.”
• Nordic Consulting is recognized with best employer awards from Comparably and Madison Magazine.
• Healthcare Growth Partners advises Council Capital and Health Enterprise Partners in their platform investment in Alivia Analytics.
• Clearsense posts a new infographic titled “The ROI of Legacy Data.”
• Impact Advisors will sponsor and present at the 2022 Analytics + CIO: Real-World AI Transforming Healthcare Now Summit November 17-18 in Scottsdale, AZ.
• Intelligent Medical Objects will exhibit at NextGen UGM November 6-9 in Nashville.
• Intrado and Loyal will exhibit at Athenahealth’s Thrive Summit October 24-26 in Austin, TX.
• Konza National Network names Claude Brunson, MD to its Board of Directors.
• Lyniate will host its Connect conference October 24-28 in Frisco, TX.
• Meditech releases a new podcast, “Reimagining the future of healthcare.”

Blog Posts

• How to Educate Multiple Generations on Security Risks and Protocols (Fortified Health Security)
• Where FHIR Currently Stands and the Future Outlook for Interoperability (HealthTech Resources)
• If you build it, they will come (Nordic)
• Free text clinical narratives in healthcare: A multi-language challenge (Intelligent Medical Objects)
• Legacy SCL Health (Now Intermountain Healthcare) Reimagines Digital Patient Access (Kyruus)
• Real-World Data: Connecting datasets with unparalleled precision (LexisNexis)
• A Digital Front Door: The Consumer Impact of Patient Access Solutions (Medhost)
• 7 Tips to Make EHR Consolidations Less Stressful (Nordic)

Contacts

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

EPtalk by Dr. Jayne 10/20/22

I went to look at the pricing and deadlines for the HIMSS23 conference earlier this week and it looks like they’re doing a little bit of a cash grab in switching up their pricing. It used to be that the basic conference pass, at the lowest price point, included access to the session records. Now you’ll have to pay an upcharge of nearly $300 for that privilege.

In addition to the recordings, the middle price point also includes access to the pre-conference forum as well as admission to the Thursday night special event. The highest price point adds on attendance at the CXO experience and the Executive Summit / Reception. I haven’t done my registration yet, so I can’t see whether there are a la carte offerings for the different items as well, but hopefully I’ll get around to that soon.

Within the last couple of years, I worked for a couple of telehealth companies. Over the weekend, one of them began texting me about surges in patient volume, despite the fact that I haven’t worked for them in months. For a while I was wondering what kind of activity happened on their system that my phone number has come back from the dead, and then it occurred to me that maybe they’ve just had a slow summer and they’re starting to see an uptick in patient requests due to the increase in cases of influenza and other viral illnesses. Regardless of the reason, texting STOP made them requests go away, which dramatically increased my provider satisfaction.

Speaking of satisfaction measures, I recently received a survey from a vendor who knows I’m extremely dissatisfied with their service. I tried to dodge it by ignoring it, but I kept being peppered by requests that appeared to be from the individual service rep, who is well aware of my dissatisfaction. I know about statistical sampling and the need to have an adequate number of responses, but it boggles my mind that they would continue to beat down the door of a disgruntled customer to the point where I felt like providing an even more negative response than I had intended to deliver. I slept on it for a couple of days then finally sent it over, trying to be as fair as possible. I hope I’m tagged in their customer relationship management as being in remediation, and that based on my very pointed feedback, that they reconsider how they’re sampling customers for routine surveys.

One of my friends reached out to ask my opinion on a medical billing situation. Apparently his insurance only covers vaccines when they’re administered in a physician’s office as opposed to covering them when they’re given at a retail clinic. At least in my community, pricing at Walgreens, Target, and CVS are all cheaper than a vaccine at a physician office and are often more convenient for the patient. I tried calling for a flu vaccine for a family member at their own primary care provider’s office, and after several weeks of trying to get through and continuing to be placed in voice mail purgatory, I gave up and took him to Costco for a quick and convenient vaccine. Fortunately it was covered by his insurance, but it just goes to show how off-kilter our current healthcare delivery system is.

Quote of the week: I loved this quote on the recent Monday Morning Update: “It’s a good lesson for vendors who think AI/ML is the universal hammer for all healthcare nails – Epic has 40-plus years of experience working with the best health systems in the country, so if it can mess up a clinical algorithm, imagine the clinical damage your cool startup and its team of former beer-ponging Facebook engineers could do.” I’ve worked on several AI and ML projects in a variety of settings, including academics, startups, and with startups that were spun off from academic medical centers. I’ve found that doing AI/ML the right way is almost universally harder than people think it is, especially if you want to ensure that you’re training your models in a way that avoids bias and works for diverse populations. If you’re like some of my former colleagues who jumped from retail IT to the clinical space and thought they knew it all, I hope you’re employing experienced clinical informaticists to save you from yourself.

This week included some adventures in healthcare, with weirdness on both the clinical and revenue cycle fronts. I had an annual visit with one of my subspecialists, who uses a scribe. Usually I find that it makes the visit more efficient, and this visit was no exception. Since we’re in the era of unbridled data sharing, I couldn’t wait to see what my visit note looked like. At this clinical office, they never take my co-pay and I always wind up receiving a bill, so I tried to pay the co-pay at checkout. They told me I didn’t have one, and I insisted that I did and offered to show them my card that said so. The clerk said she would check in the system and figure it out, then came back with a “definitely no co-pay” verdict. I asked her to check the practice management system, where she’d clearly see my annual visits and the subsequent copay being billed and my payments, but she refused. This is the only office I’ve been to that refuses cash at the time of service, so I’m not sure what era their billing team is living in.

The weirdness continued when I returned home and looked at my visit note, which was already available. Imagine my surprise when I saw the documentation that the patient had completed a questionnaire, including a comprehensive review of systems, and that I had discussed it with the physician, since neither of those events occurred. The templated documentation also noted that the document was scanned, which is interesting because I’ve never completed anything like that at this office. This is the second time this year I’ve been confronted with erroneous visit notes and I’m still wondering what the best way is to handle them. In this case, it doesn’t impact the outcome of the visit or my future care, so I’m not that excited about bringing it up. In the other case, there were material errors in the chart, but I still don’t know the best way to deal with them. I’ve decided to leave that provider’s care anyway, and the errors aren’t anything that are going to impact future care or payments or anything else, but they’re just annoying.

Have you had errors in your visit documentation after seeing a healthcare provider? How did you handle the situation? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/20/22

Over 41,000 VA Patients Warned of Delayed Care Due to Troubled Electronic Records System

The VA notifies 41,000 patients that their care may have been delayed due to problems with the department’s Oracle Cerner-powered EHR, further implementations of which have been delayed.

EngagedMD Raises $11MM in Funding Round Led by MonCap for Growth in the Fertility Space and Beyond

EngagedMD, which offers patient education and informed consent technologies for fertility practices, raises $11 million.

HHS Office for Civil Rights probes ‘hacking/IT incident’ at Defense Health Headquarters

The HHS Office for Civil Rights investigates a cybersecurity incident at Defense Health headquarters that may have impacted 1,279 people.

Morning Headlines 10/19/22

Inbound Health Launches to Enable Partners to Build and Scale Hospital and Skilled Nursing Facility-at-Home Care Models

Minnesota-based Allina Health and Flare Capital Partners launch Inbound Health, which will help other health systems develop tech-enabled, home-based care programs.

BioIntelliSense Acquires AlertWatch® Clinical Intelligence Engine to Expand its Comprehensive Portfolio of Continuous Patient Monitoring Solutions

Remote patient monitoring technology vendor BioIntelliSense acquires Alert Watch, which offers data aggregation for clinical monitoring.

Redi.Health Secures Financing to Accelerate Availability of Health Management Platform for Patients with Chronic Diseases

Chronic disease patient support app developer Redi.Health raises $3.7 million in seed funding.

News 10/19/22

Top News

Minnesota-based Allina Health and Flare Capital Partners launch Inbound Health, which will help other health systems develop tech-enabled, home-based care programs.

The new company is backed by an initial funding round of $20 million.

Former Mount Sinai Chief Product Officer and Head of Consumer Digital Innovations Dave Kerwar, MBA joins Inbound as CEO.

Reader Comments

From Digital Triplet: “Re: SDOH platforms. Findhelp, the NC low bidder you mentioned, has been working to publicize apples-oranges comparisons to Unite Us and to influence procurement activities in several states (OH and NH come to mind). They even got NH policymakers to make the kind of information sharing that Unite Us enables illegal, the David in your David and Goliath metaphor throwing stones at the big guy.” Unverified. New Hampshire’s SB 423 addressed privacy issues with the state HHS’s choice of Unite Us. It limits its storage of information to residents who are receiving HHS-funded services who consent to each instance of a referral and also prohibits provider users from viewing the information of people who haven’t been referred to them. 

From Morpheus: “Re: SDOH platforms. Unite Us is already the market leader after its acquisition of NowPow. Potential competitors would need to offer these advantages.” The provided list includes:

• A better user interface, especially the use of smartphones as point-of-service data capture tools.
• Lower cost.
• Better interoperability for social care referrals and loop closure of documentation of services. This would need to come from the federal government and ONC, where any program that gets federal money should have software that complies with interoperability standards. It would not be necessary to have a single statewide or regional system if smaller systems could communicate.

Meanwhile, Forbes updates its article on North Carolina’s selection of Unite Us with a statement from the company, which insists that it won the state’s business competitively and refers to a 2020 press release from UNC Health that describes its reasons for joining NCCARE360 and its Unite Us platform.

Webinars

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

Acquisitions, Funding, Business, and Stock

Patient communication platform vendor Well Health changes its name to Artera, as celebrated by the privately held company’s Chief Revenue Officer John Knotwell and CEO Guillaume de Zwirek.

Infusion pump data management vendor Bainbridge Health, a spinoff of Children’s Healthcare of Philadelphia, raises $3.4 million.

Remote patient monitoring technology vendor BioIntelliSense acquires Alert Watch, which offers data aggregation for clinical monitoring. Alert Watch founder and CEO Kevin Trempher, MD, PhD, who is also a professor at University of Michigan Health, earned a Cal Berkeley PhD in chemical engineering, an MD from University of California Irvine, and residency in anesthesiology from UCLA Medical Center before changing his emphasis to perioperative care systems in the 1990s.

Calm, which offers sleep and meditation apps, will launch Calm Health, a mental health and provider-caregiver communication app. Calm acquired care coordination platform vendor Ripple Health early this year.

Ari Gottlieb of A2 Strategy notes that health tech companies have lost $215 billion in market value, 81% of their total, as investors continue separating real business prospects from hype. He identifies some of the worst-performing companies — Babylon (down 98%), Teladoc Health (which has shed $46 billion in value down to $4 billion), and GoodRx and Amwell (down 92% from previous highs). He says that the only digital and telehealth company that is up in the past nine months his Hims & Hers, which shows that “selling ED pills to college kids” may be a recession-resistant strategy.

Sales

• University of Rochester Medical Center (NY) will implement Sectra’s enterprise imaging technology via cloud-based subscription service.
• Redox selects IMO Precision Normalize from Intelligent Medical Objects to standardize health data for its customers.
• A new hospital in Germany will deploy Ascom’s Telligence patient call system.

People

Gerald Greeley, MHA (Lawrence General Hospital) joins Shields Health as CIO.

Thanh Tran (South Shore Health) joins MaineHealth as VP/CTO.

Hugh Cassidy, PhD, MBA (True Blue Partners) returns to LeanTaaS as chief data scientist.

Caryn Bremer (In Compass Health) joins Eagle Telemedicine as VP of licensing and credentialing.

Annexus Health promotes David Meier to CTO and names Katy Wile (Huron) VP of product delivery.

Cognizant-owned  TriZetto Healthcare Products promotes Michael Pierce to COO.

Announcements and Implementations

Fort HealthCare (WI) implements Fresenius Kabi’s interoperable Ivenix Infusion System. The drug producer acquired Ivenix in March for $240 million.

Kirby Medical Center (IL) goes live on automated medical documentation software and real-time clinical support from Augmedix.

Amazon Web Services launches Landing Zone Accelerator for Healthcare for customers to maintain security and compliance in the cloud.

Oracle EVP Mike Sicilia tells Oracle Cerner Health Conference attendees that healthcare is Oracle’s highest priority and primary mission. Oracle Cerner also previewed its Advance dashboard, says that its Seamless Exchange integration product is nearing release, and highlighted its RevElate patient accounting solution that will be released in the next few weeks.

GE Healthcare will integrate Tribun Health’s digital pathology solution into its vendor-neutral archive.

Digital patient prescription tools vendor Custom Health acquires Health in Motion Network, which offers pharmacy patient health recordkeeping app. Health in Motion’s CEO is Ray Shealy, who has held executive roles at McKesson and T-Systems.

A new KLAS report on credentialing solutions finds that users of ASM’s MD-Staff report a paperless process that has decreased FTEs and turnaround time, with customers also giving good marks to Modio Health’s OneView and RLDatix’s Verge Health solutions.

Government and Politics

A KHN article says that federal law requires that government resources be accessible to patients with disabilities, but the VA’s Oracle Cerner system doesn’t support blind or low-vision users with text enlargement or text-to-speech options. The VA has received over 1,000 Section 508 complaints about Oracle Cerner, of which 469 have been accepted by the company to fix. A VA anesthesiologist complains of small icons and the need for multiple high-resolution monitors to display a patient’s entire record, while  a team at one VA facility found that it doesn’t support text-to-speech. Unrelated to Oracle Cerner, a survey by the American Federal for the Blind found that more than half of respondents have struggled with using proprietary telehealth systems, especially hard-to-read chat sidebars, and some resorted to using FaceTime.

The Department of Justice sues Cigna, claiming that the insurer inflated the diagnosis codes of Medicare Advantage patients to boost payments. DOJ says Cigna’s contracted nurse practitioners did not order testing or imaging to support the complex diagnoses they submitted from home visits whose entire purpose was to increase billing for the most potentially lucrative patients rather than to deliver care

Consumers with mild to moderate hearing loss can buy hearing aids without a prescription in an FDA rule change that took effect Monday. Best Buy has already launched an online hearing test and sale of 26 hearing aid models at prices ranging from $199 to $2,950. The Bose-powered models above offer self-tuning via a mobile app, preset templates for specific environments such as TV watching or restaurants, and video or voice call support directly from the app.

Privacy and Security

Virginia Mason Franciscan Health (WA) works to restore IT systems impacted by the ransomware attack on parent organization CommonSpirit Health earlier this month. VMFH officials say providers are now able to access patient medical records, and that the patient portal should be back up and running in a few days.

Other

Yale New Haven Health System will spend $400 million to buy three for-profit hospitals with 700 total beds, citing the value of having all hospitals running Epic. Connecticut’s healthcare advocate says he hopes that YNHHS’s interoperability zeal will extend to having all of its hospitals participate in the new Connie statewide HIE.

A technology analysis firm predicts that Apple will partner with a US insurer in 2024 to offer health insurance that incorporates sensor data from its Watch. I see little connection with health insurance and Watch’s short list of minimally relevant physiologic measurements, but perhaps some insurer will offer Watches (especially to the Medicare Advantage audience that loves perceived freebies) as an inducement to sign up.

Sponsor Updates

• Surescripts awards its White Coat Award to 10 healthcare industry leaders in e-prescription accuracy.
• Clearsense rebrands its healthcare data management and analytics platform to 1Clearsense.
• Netsmart exhibits at the 2022 LeadingAge Annual Meeting and Expo through October 19 in Denver.
• Azara Healthcare releases a new case study, “Alaska Health Centers Improve Diabetes Care Through Data-Driven Healthcare Model.”
• The North Carolina Dept. of IT wins a State Government IT Award from the National Association of State CIOs in the Business Process Innovations Category for the healthcare outcomes it achieved with Bamboo Health’s OpenBeds platform.
• Biofourmis will present at the American Academy of Home Care Medicine October 28 in Orlando.
• Oracle Cerner debuts new patient accounting solution RevElate at its annual conference.
• Clearsense publishes a new case study, “Using Clearsense 20/20 to Predict Renal Failure.”
• CloudWave will exhibit at the HIMSS New England HIE Conference October 20 in Worcester, MA.
• Meditech expands its population health management offering with Expanse Population Insight, powered by Innovaccer’s data platform.
• Diameter Health will exhibit at the NCQA Health Innovation Summit October 31-November 3 in Washington, DC.
• EClinicalWorks announces that Advocare has achieved $1 billion in collections using EClinicalWorks RCM.
• Ellkay will exhibit at Athenahealth’s Thrive conference October 24-26 in Austin.

Blog Posts

• All-payer connectivity: 3 ways to close the gaps between providers and payers (Ability Network)
• Practice Management Software Market Insights: Boosting Healthcare Service Efficiency (AdvancedMD)
• Introducing ‘That’s life in flow’ at RSNA 2022 (Agfa HealthCare)
• Leveraging Your Revenue Cycle to Influence Health Equity (AGS Health)
• 3 reasons your organization needs an electronic attachments solution (Availity)
• 76% of Health Workers are Burned Out – How Tech Can Help Now. (CareMesh)
• Meditech Expanse Implementation: Use Automation to Win the Battle Against Time (CereCore)
• Lessons from Heathrow: A New Approach to Tech Preparedness in Healthcare (Commure)
• Optimizing EHRs from Implementation Through Post Go-Live (CTG)
• Using Analytics to Get a Pulse on the Health of Your Emergency Department (Dimensional Insight)
• How Leaders and Team Members Can Prioritize Mental Health (Divurgent)
• How a Remote Solution Keeps Patients Close (EClinicalWorks)

Contacts

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

Morning Headlines 10/18/22

Cityblock Health Creating 140 New Jobs

Cityblock Health will bring 140 jobs to Indiana when it begins providing tech-enabled care for MDwise members in Indianapolis and Fort Wayne.

Eyenuk secures $26 Million Series A funding to accelerate global access to AI-powered eye-screening technology

AI-powered eye-screening software company Eyenuk raises $26 million in a Series A round, bringing its total funding to $43 million.

Vanta lands $40M to automate cybersecurity compliance

Multi-vertical cybersecurity company Vanta raises $40 million in a Series B extension that brings its total raised to $203 million.

Curbside Consult with Dr. Jayne 10/17/22

When I speak with physicians who don’t have a lot of experience with using telehealth for urgent care patients, they’re always concerned about quality. Many of them aren’t aware of some of the different techniques you can use to assess patients, or the ways you can instruct a patient to perform different maneuvers to help in that assessment.

It seems kind of funny at times, because in medical school we were always encouraged to remember that the patient’s story often provides the majority of information needed to narrow the options for diagnosis. Despite what we might think in a world of high-tech diagnostics, it’s not always about doing a lot of tests or even about performing hands-on examination techniques.

In my time as a “fast track” physician in a high-volume emergency department, I’ve seen a lot of patients who did not truly need emergency services. As telehealth expanded during the COVID pandemic, hospitals were looking at different ways to manage increasing emergency volumes and figuring out different ways to care for patients who didn’t need high acuity care. Some organizations turned to telehealth, adding phone booth-style cubicles where patients who met certain triage criteria could consult with a physician. Others moved to a “physician in triage” model to help expedite care, although that occasionally backfired when patients left after being triaged but were still stuck with a bill since they were seen by a physician.

With that in mind, I was excited to see an article last week in NEJM Catalyst that examined this phenomenon. Titled, “Converting an ED Fast Track to an ED Virtual Visit Track,” the case study looks at the Stanford Health Care experience as it substituted remote consultations for in-person visits in the emergency department. The effort started in December 2020, as the organization accelerated an already-approved plan to add virtual visits into the ED’s offerings. As we’ve seen with a number of technology initiatives across the US, the challenges posed by the COVID pandemic led to many different advances in care delivery capacity.

Historically, the goal of a fast-track area within an emergency department is to be able to treat low-acuity patients faster, since higher-need patients will always be prioritized. Typically, the fast-track area has dedicated physicians and nursing staff who can quickly evaluate and manage a variety of non-emergent problems, such as cough/cold, sore throat, ear pain, rashes, nausea, vomiting, diarrhea, low-grade burns, minor lacerations, sprains, lower-acuity fractures, and the like. On any given shift in the fast track, I’d see kids who were sent home from school too late to get an appointment with their primary care physician, people who were injured at work, and those who might not have a primary physician or other access to healthcare but who had run out of prescription medications or had other care needs.

At my hospital, the fast track was staffed by family physicians since the majority of patient complaints were the kinds of things we see in our offices day-in and day-out. That freed the board-certified Emergency Medicine physicians to manage more complex cases, including strokes, heart attacks, major traumas, gunshot wounds, serious burns, etc. It sounds like Stanford’s fast track unit was a lot like mine, with its own physicians, nurses, and ED technicians. However, due to COVID surges, Stanford implemented a Virtual Visit Track in place of its fast track, adding the offering to both adult and pediatric emergency departments. In that program, a physician is seeing low-acuity patients from a remote location, while dedicated support staff in the emergency department provide services that must be done in person.

In the Stanford program’s first year, 2,000 patients received virtual care through the offering. The volume of patients has been sustained, with around 1.5 patients per hour being diverted into the virtual visit track during an eight-hour shift. This metric was tracked closely since 12 patients per shift was the break-even point for the resource investment. The wait time for patients in the virtual track was around 1.9 hours compared to 4.2 hours for patients seen in-person for the same level of care.

Additionally, researchers looked at the quality of care being delivered, comparing virtual care to the standard in-person care normally available. The virtual care was found to be non-inferior. Research also showed that virtual patients had a lower median return visit rate than in-person patients, although the numbers were not statistically significant.

It’s great that this type of research is being performed so that we know whether the interventions we’re applying to the healthcare system are actually effective or if they’re just another shiny object that we thought would make a difference but didn’t. We’ve all seen plenty of the latter over the years, as hospital administrators brought back ideas from conferences and did a lot of “transformation” work without knowing for sure it would work.

I remember when my hospital jumped on the Disney Institute bandwagon back in the mid-2000s. A lot of money was spent on educational in-services, culture promotion, institution of dress codes, and uniformity across patient care units. I’m not sure any of it did much to drive patient outcomes or to retain staff. Frankly, as far as the latter, I think re-engineering the hospital cafeteria’s late-night offerings did a lot more to boost morale than the Disney principles ever did.

I was involved in a “virtual first” offering with one of my clients a couple of years ago, and it was an interesting experience. I know how my visits went, but when we looked at the work of all the clinicians on the panel, there was a lot of variety. Unfortunately, the program was slow to grow, and during my time there, we never had enough visit volume to get to the point where any research would have been statistically significant. Seeing this article makes me want to reach out to my successor and find out what their volumes have been since I left and if they’ve been doing any quality work. It would be gratifying to know that something I helped get off the ground was making a difference.

Has your organization done any work looking at the quality of virtual offerings compared to standard care? Is it a case of the newer offering being merely “non inferior” or does it really shine? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Five Lessons from the Five Years Since the EClinicalWorks Settlement

Five Lessons from the Five Years Since the EClinicalWorks Settlement
By Colette Matzzie, JD

Colette Matzzie, JD is an attorney and partner with Phillips & Cohen, LLP of Washington, DC.

The June 2017 announcement by the Department of Justice of a $155 million settlement with EClinicalWorks for alleged misrepresentation of the capabilities of its electronic medical record software heralded the start of a new area for health fraud enforcement. Both DOJ and the HHS – Office of Inspector General announced that investigations of alleged fraud involving electronic health records systems would be a top enforcement priority. Enforcement has continued at a steady clip, with DOJ bringing actions against six additional electronic health records vendors. There is every reason to think more will be forthcoming.

Most actions have been initiated by whistleblowers using the False Claims Act, but, at least two actions, including one resulting in a $145 million settlement, were initiated by the government.

Five lessons can be drawn from this period of robust enforcement.

DOJ and HHS-OIG have made good on their promise to investigate allegations of fraud in the development and implementation of electronic health records.

Since June 2017, five settlements and one additional intervention have been announced:

• February 2019 settlement with Greenway for $57.25 million.
• January 2020 settlement with Practice Fusion for $145 million.
• August 2020 settlement with Konica Minolta for $500,000.
• January 2021 settlement with Athenahealth for $18.25 million.
• April 2021 settlement with CareCloud for $3.8 million.
• March 2022 intervention in a pending qui tam against Modernizing Medicine.

The US Attorney in Vermont has led the way, but with US attorneys in Northern Georgia, Northern California, New Jersey, Southern Florida, and Massachusetts joining in. Five of the cases were initiated by whistleblowers. Three settlements (EClinicalWorks, Greenway, and Practice Fusion) required Corporate Integrity Agreements (CIAs) with OIG with ongoing federal oversight of software development, relationships with customers, and financial arrangements.

Financial relationships between electronic medical record companies and providers have been a major enforcement focus.

All but one settlement allege violations of the federal Anti-Kickback statute, which prohibits the payment of remuneration to induce referrals for items or services paid for by federal health programs. For example, DOJ alleged that CareCloud provided customers with credits, cash bonuses, and other payments to recommend the software and not to say anything negative. We can expect vigorous enforcement of the Anti-Kickback statute for health IT vendors where federal payments, whether under the Meaningful Use or Promoting Interoperability programs or otherwise, provide the necessary federal funding hook for allegations.

Kickbacks paid to EMR vendors by pharmaceutical companies and other third-party medical providers to influence clinical decisions are also ripe for enforcement.

Of major significance is the January 2020 resolution of criminal and civil charges with Practice Fusion for soliciting and receiving kickbacks from a major opioid company for utilizing its EMR to influence physician prescribing of opioid pain medication. Clinical decision support is an essential requirement for EMRs to deliver their promise of evidence-based clinical care. The Practice Fusion settlement brought scrutiny on EHRs leveraging their power to influence clinical decisions and extracting payments from pharmaceutical companies to implement CDS tools to increase prescribing of the sponsor’s drugs. This practice threatens to undermine the promise of EMRs to improve patient health in favor of profits for the EHR vendor.

Individual accountability has been an important feature of EMR enforcement actions.

DOJ’s interest in holding individuals accountable for corporate wrongdoing has peaked in the last five years and can be seen in a wide variety of industries. No less with EMR enforcement, DOJ has held accountable individuals for their participation in alleged misconduct involving EMR software. In EClinicalWorks, three of the company founders were held jointly and severally liable for payment of nearly $155 million, with three others responsible for smaller payments for their role. Health IT companies can expect continued scrutiny of the knowing decisions of individuals.

Future enforcement actions will include recovery of funds spent as part of the Merit-Based Incentive Payment System or MIPS.

Damages in the EClinicalWorks settlement recovered payments made under the Meaningful Use program. But recent settlements have also referenced recovery of payments under MIPS. There is every reason to think that DOJ will continue to seek recoupment from vendors of the portion of payments allocated for compliance with Promoting Interoperability requirements. Likewise, one should anticipate that DOJ and OIG will turn to enforcement of the Cures Act, including compliance with interoperability and information blocking mandates.

Readers Write: The Clinical Dilemma at the Tipping Point – How We All Can Drive Transformation in Healthcare

The Clinical Dilemma at the Tipping Point – How We All Can Drive Transformation in Healthcare
By Ted Ottenheimer

Ted Ottenheimer is VP of clinical data transformation for Ascom Americas of Morrisville, NC.

I have read countless articles regarding the shortage of staff in healthcare. I have experienced it myself in the pre-hospital EMS (emergency medical services) setting. So much of what I read provides a great depiction of the situation in which we find ourselves, yet few of them offer solutions. If you’re a nurse, administrator, leader, institution, or anyone interested in the healthcare field, I’m sharing my perspective here on how to be part of the change.

When I first left the military, I was looking for a nursing school to expand my career. The one I had intended to apply to, hosted right in the hospital, was closing its final year of the program. I was left to search for a college that I could attend in a traditional manner. As a single father, this posed a challenge, as I had to continue to maintain gainful employment.Hence, I entered the workforce. 

From time to time, I would look for that nursing opportunity. I finally found it two years ago in a program that runs on evenings and weekends with manageable clinical time during the standard work week. I wish I was 20 years younger, but I believe you are never too old to pursue your dreams.

Now is the time to invest in the programs necessary to continue turning out the critical staffing that the ever-changing healthcare industry is demanding – nursing aides, LPNs, RNs, RTs, and so on. What if these programs have more to offer for non-traditional students? What if programs are brought back into the health system? Partnerships between hospitals and higher learning can be successful, although I understand the prestige associated with being able to attend these opportunities for higher learning is a fierce battle of minds in which only the highest aptitude may attend. However, capacity continues to be an issue to provide the necessary staffing, and we need to think creatively to solve today’s challenges. 

To make a change requires a significant amount of effort and the ability to think outside the box. Let’s look at an example of a way that we made a change. The minimum provider level to staff an ambulance is an emergency medical technician – basic. There is an aide position that requires less training called an emergency medical responder. After years of work by some determined individuals, they were able to incorporate this into the local high school curriculum. The intention is to engage the students in assisting our local community. This is similar to having a CNA (certified nurse’s aide) program in high school or vocational / technical school. Both examples are great options to engage at an early age with hopes of pursuing a career in the healthcare field. It amazes me how many doctors and nurses I have spoken with whom have been trained in EMS, which drove them to continue in healthcare.

We see that there are policies in place for continuing education in nearly all of the health systems. Are you seeking out the employees with potential? I suspect with the current burnout rate it is difficult to think of continuing education. However, helping build one’s career is always rewarding in both directions. I will always remember those leaders who have taken the time for me and encouraged me to work towards improvement.

My last point is adopting technology. Clinical staff are caring for more patients than ever before. As the workload increases, the cognitive load grows as well. This situation will not diminish any time soon.  Technology can assist in capturing routine clerical entries, alerting clinicians to actionable patient events, provide collaboration tools, and clinical decision support that can reduce the burden on staff. It will reduce the negative outcomes we all worry about and want to avoid.  Engage the clinicians early in the process and watch them become the champions for you.  Take some time to see what is most important to them by reading our recent report, “Nursing Satisfaction: What Matters Most At Work.”

These are some simple concepts that can be the change that is so desperately needed in healthcare today.

Morning Headlines 10/17/22

CHOP spinout Bainbridge Health raises $3.35M

Infusion pump data management vendor Bainbridge Health, a spinoff from Children’s Healthcare of Philadelphia, raises $3.35 million.

Redox Sets the Stage for Composable Healthcare, Expands Internationally

Redox expands into Canada and offers API Actions, which describes specific data models as concepts that developers can more readily understand.

Custom Health Acquires Health in Motion Network

Personalized medication management company Custom Health acquires Health in Motion Network, which has developed wearables data aggregation and tracking software for patients.

Monday Morning Update 10/17/22

Top News

The VA pushes back its next Oracle Cerner go-live from January 2023 to June 2023.

VA Deputy Secretary Donald Remy says that the “assess and address” period is necessary because “the Oracle Cerner electronic health record system is not delivering for veterans or VA healthcare providers.”

VA Secretary Denis McDonough announced in July that further deployments would be delayed until January 2023 while technical and system problems were resolved. The VA was set to roll the system out to 25 VA medical centers in 2023.

The VA is sending letters to every veteran who may have been impacted by system problems at its five live sites, asking them to call the VA if they experienced delays in prescription filling, appointments, referrals, or test results.

Reader Comments

From State of Confusion: “Re: NC and Unite Us. The $14 million state SDOH referral platform procurement was funded via solicited donations from Medicaid MCOs that were paid to Foundation for Health Leadership and Innovation, which took a 10% cut off the top. State HHS appears to have chosen its vendor and terms, then asked MCOs to foot the bill instead of going through state IT procurement. Also, a competitor that bid $500K for the project was shut out via service contracts that prohibited the use of competing systems.” Unverified. Unite Us is the Goliath among mostly David-sized SDOH competitors, having raised nearly $200 million from big names such as Salesforce, Andy Slavitt’s Town Hall Ventures, and Optum, with a Series C round last year valuing the company at $1.7 billion. I know little (but suspect much) about state IT procurement, but more knowledgeable readers are welcome to chime in. Federal taxpayers gave North Carolina HHS $650 million to test and evaluate non-medical Medicaid interventions, such as those related to food and housing, in its Healthy Opportunities Pilots.

From D. L. Roth: “Re: Epic. Are they trying to dodge the FDA by changing their sepsis algorithm and definition of sepsis, or is it normal for a software company to define a clinical outcome?” I can’t see the paywalled article, but the lead paragraphs say that Epic now recommends that hospitals train the sepsis model on their own data and has changed its definition of a sepsis to a more commonly accepted standard that relies less on the existence of antibiotic orders. A just-published article in Journal of Critical Care compares nine hospitals that implemented Epic’s sepsis prediction tool to six that did not, concluding that the Epic tool didn’t improve outcomes. A JAMA-published study from 2021 concluded that “the Epic Sepsis Model poorly predicts sepsis” and generates many false alarms, questioning why so many hospitals were using it in the absence of peer-reviewed clinical validation. That’s probably the real story – not that an EHR vendor developed a clinical tool that didn’t work as planned, but that hospitals blindly started using it to support patient care without digging deeper. Still, the tool is advisory rather than prescriptive, at least when used as intended, and thus should elicit little FDA regulatory interest. The sepsis advisor may not have helped patients as much as Epic and its client hospitals had hoped, but it also didn’t hurt them. It’s a good lesson for vendors who think AI/ML is the universal hammer for all healthcare nails — Epic has 40-plus years of experience working with the best health systems in the country, so if it can mess up a clinical algorithm, imagine the clinical damage your cool startup and its team of former beer-ponging Facebook engineers could do.

HIStalk Announcements and Requests

The most valuable mid-career credential to earn is a master’s degree or vendor-specific certification, poll respondents say, although I’ll asterisk those results because they are driven by the number of respondents who actually earned one of the listed credentials.

New poll to your right or here: If your job allowed you to live anywhere, what top three factors would be most important in your choice?

Mike generously donated to Donors Choose in offering “Continued thanks to you, Mrs. H, Dr. Jayne, and all the other content contributors.” I applied matching funds to fully fund these classroom projects:

• Headphones and clocks for Ms. M’s second grade class in Phoenix, AZ.
• Force and motion exercises for Ms. D’s elementary school class on Apollo Beach, FL.
• Headphones for the third grade class of Ms. Z in Orlando, FL.
• Activities and resources for Ms. N’s first grade class in Arlington, TX.
• Math books and games for Mr. C’s middle school class in Phoenix, AZ.
• STEM robotics and Lego kits for Ms. W’s middle school class in Margate, FL.
• STEM activity kits for Mrs. S’s elementary school class in San Bernardino, CA.

I’ve heard from most of the teachers already, including Ms. N, who said, “I am so grateful; but more importantly, our students will be. Your generosity, support, and investment is so appreciated. Our students will be able to enjoy this resources for many, many years to come!”

My recovery from “The COVID” remains uneventful nearly a week in, with my only symptoms over that time being a couple of early days’ worth of mild stuffiness and a scratchy throat. I’m remaining sequestered until midweek, although CDC guidelines say I can rejoin society now as long as I wear a mask.

Great news: the cringey “reaction GIF” – painfully unoriginal video clips posted on social media by people who are unwilling or unable to use actual words — is dead, retired to the Internet boneyard by Facebook-using boomers who still believe them to be clever.

Webinars

October 18 (Tuesday) 2 ET. “Patient Payment Trends 2022: Learn All The Secrets.” Sponsor: Mend. Presenter: Matt McBride, MBA, co-founder and CEO, Mend. Many industries offer frictionless payments, but healthcare still sends paper bills to patients who are demanding modern conveniences. This webinar will review consumer sentiment on healthcare payments, recent changes to the Telephone Consumer Protection Act that create opportunities for new patient financial engagement, and new tactics to collect more payments faster from patients.

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

Acquisitions, Funding, Business, and Stock

The CEO of CVS Health says that the company will be involved in the “entire spectrum of someone’s health journey,” which includes health insurance via its Aetna business, MinuteClinic care delivery, pharmacy, and with its recent acquisition of Signify Health, the provision of in-home care. Karen Lynch also says the company will make a primary care acquisition later this year and will expand its digital offerings since otherwise “we’re never going to get that connected care and that personalized care.” She says that Amazon is a transactional company, while CVS has earned the right to be in healthcare, particularly via its COVID-19 vaccination program.

People

Lee Westerfield, MBA (Dstillery) joins Clearsense as CFO.

Announcements and Implementations

Vanderbilt and Brigham and Women’s will study the use of Synapse’s clinical decision support and medication reconciliation software to analyze drug-related risks and optimize medication appropriateness, as integrated with their Epic workflows.

Redox expands into Canada and offers API Actions, which describes specific data models as concepts that developers can more readily understand.

The National Association of ACOs asks CMS to conduct pilots of ACO submission of EHR-extracted quality of care data before mandating electronic submission. It also wants CMS to eliminate the requirement that ACOs report data on all patients from all payers, saying that ACOs that serve vulnerable patients will look work in CMS comparisons because of their sicker populations. A NAACOS survey finds that 39% of ACOs use more than 10 EHRs and only 17% use just one, forcing them to rely on third-party aggregators.

Government and Politics

An MGMA report finds that the most burdensome regulatory issue of medical practices is prior authorization, while the second is the No Surprises Act requirement that practices give good-faith estimates of out-of-network costs in advance.

Privacy and Security

In England, NHS software provider Advanced confirms that an August 4 cyberattack involved LockBit ransomware and that data was exfiltrated from Staffplan and Caresys customers. The hacker penetrated the Advanced network by using third-party credentials to establish a remote desktop session to its Staffplan Citrix server, from which it navigated the network to deploy malware. In a fascinating back story, the LockBit development team released Version 3.0 of the “ransomware as a service” that it promised would “Make Ransomware Great Again,” after which a disgruntled developer breached its systems and released the builder program on Twitter so that rival ransomware groups could use it without paying a percentage of the ransom.

Other

A Canada-based engineering society demands that “software engineers” stop using that title because they are not licensed or regulated like all other engineers.

A Minnesota health system halts plans to build a new clinic due to costs of switching its Epic host from Allina Health to OCHIN.

Bizarre: 200 decomposing bodies are found on the roof of a hospital in Pakistan, apparently placed there by its mortuary, which initially refused to allow inspectors to enter. Meanwhile, a health minister in India continues his surprise inspection of hospitals and firing those in charge for problems that include requiring families to buy patient medicines elsewhere, night nurses who don’t answer patient calls, clinicians who are absent but clocked in, and dogs running loose on the wards.

I’m honoring the memory of HIS-torian Vince Ciotti and the sunny slopes of yesterday by surfacing a LinkedIn post by Tom Sullivan on an upcoming reunion of former employees of Ray Forgit’s Medical Systems Management, which merged with Picis in 2002. Let me know of similar reunions or online groups since I’m a sucker for former health IT employer nostalgia.

Sponsor Updates

• OptimizeRx reports strong results from a recent program that used its patent-pending AI technique and real-world data to improve time to diagnosis and therapy for a complex disease.
• The Shasta County Health & Human Services Agency expands its implementation of Netsmart’s CareFabric platform to better support the California Advancing and Innovating Medi-Cal program.
• Sectra will install the radiology module of its enterprise imaging solution throughout German ANregiomed’s healthcare system.
• BCBS of Massachusetts uses Olive’s AI and automation to speed review time, automate authorizations, and eliminate administrative costs in a pilot project with New England Baptist Hospital.
• Optum releases its first Pharmacy Insights Podcast, “What’s happening in specialty pharmacy?”
• Aurora Mental Health Center reduces time to remission by 56% and increases access by 30% with Owl’s measurement-based care platform.
• Premier’s Contigo Health subsidiary completes its asset transaction for national provider contracts and licenses to cost-containment technology from TRPN Direct Pay and Devon Health.
• Redox releases a new podcast, “Patient Experience & Healthcare’s Move to the Cloud with ConvergeOne’s Matt Vestal.”
• Sectra launches its Let’s Talk Enterprise Imaging Podcast with three new episodes.
• Sphere will exhibit at Athenahealth Thrive 2022 October 24-26 in Austin.
• Surescripts releases a new There’s a Better Way: Smart Talk on Healthcare and Technology Podcast, “An Antidote to Clinician Burnout: Fusing Old-Fashioned Medicine with High Technology.”
• Talkdesk awards 2022 CX Innovator Awards to Alignment Health and Carbon Health.

Blog Posts

• Culture & Focus on Clients Fuel Growth (Pivot Point Consulting)
• Technology: A Lifeline for Burned-Out Nurses (PerfectServe)
• 8 Ways to Reduce Alarm Fatigue in Hospitals (Spok)
• Why Does Clinical Experience Matter in Healthcare IT Leadership? (Optimum Healthcare (IT)
• Call center service level and customer satisfaction (Talkdesk)
• How Healthcare Technology Can Bridge the Gap in Patient Communication (TigerConnect)
• What is a TPE Audit, and How Should You Handle It? (WebPT)

Black Book’s latest ranking of coding, transcription, CDI, and clinical information management software and services vendors include the following HIStalk sponsors:

• Comprehensive mid-RCM coding, CDI and compliance solutions – inpatient hospitals and health systems: Nuance.
• Comprehensive mid-RCM coding, CDI and compliance solutions – physician practices and ambulatory providers: Nuance.
• Clinical data interoperability solutions: Redox.
• Medical speech recognition and AI solutions: Nuance.
• EMPI and clean-up: Verato.
• Computer-assisted coding applications: Optum360.
• Vendor-neutral archive: Agfa HealthCare.

Contacts

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