News 4/3/24

Top News

Risant Health completes its acquisition of Geisinger, which will become its inaugural health system.

The non-profit Risant Health, which will focus on value-based care, expects to acquire up to five community health systems in the next five years.

Reader Comments

From Anonymous IT: “Re: Intermountain Health. Layoffs of 500+ last week in the Nevada Region, plus demotion offers to others.” Unverified.

Webinars

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

Acquisitions, Funding, Business, and Stock

Business Insider reports that Surescripts is exploring a sale of the business, which is 50% owned by pharmacy benefit managers CVS Health and Express Scripts and 50% owned by pharmacy trade groups. Insiders say the ownership structure could complicate the sale, adding that a private equity firm is the most logical buyer because of transaction’s expected high price and the need to balance the needs between the PBM and pharmacy owners.

Praia Health secures $20 million in Series A funding. The company, which was spun out of the Providence health system in October 2023, offers automated personalization of a patient’s care journey for improved engagement.

3M spinoff Solventum, which includes health information systems among its four business segments, begins trading on the NYSE.

Axios reports on the “economic and operational nosedive” of Amwell, whose valuation has dropped from $10 billion in late 2020 to $235 million now. The article says that Amwell overpromised, botched product rollouts at big clients like CVS Health and Memorial Hermann, and failed to develop a post-pandemic strategy. AMWL shares took another drop when the article ran, down 66% in the past 12 months.

Sales

• Intermountain Health (UT) will use Sensorum Health’s remote patient monitoring technology as part of a house calls pilot program for homebound seniors who have chronic conditions.
• Hartford HealthCare will implement Axuall’s clinician onboarding system.

People

Alan Tam (Actium Health) joins Reveleer as chief marketing officer.

Harmony Healthcare IT names Kelly Hahaj (Indiana Health Information Exchange) VP of corporate development.

Announcements and Implementations

Commure launches Scribe, a free ambient documentation tool for its users that integrates with EHRs such as Epic, Athenahealth, and Meditech.

Availity announces Predictive Editing, an AI claims denial prediction tool for its Availity Essentials Pro RCM platform.

Ascom launches RemoteWatch, a remote monitoring service for its Ascom Healthcare Platform that allows hospitals to identify technical issues.

Eko Health earns FDA clearance for its AI-powered heart failure detection for its stethoscopes. The technology — which will be added to the company’s Sensora Cardiac Early Detection Platform that diagnoses atrial fibrillation and heart murmurs — identifies low ejection fraction. Mayo Clinic developed the algorithm and is an investor in Eko.

Greenway Health integrates DrFirst’s RxInform prescription notification and patient engagement software with its Intergy EHR.

Connect Oregon, the state’s coordinated social care network, adopts payment software from Unite Us to improve Medicaid billing amongst its nine Coordinated Care Organizations.

Verato develops its Identity Data Management Maturity Model to help healthcare organizations assess, benchmark, and improve their identity data management processes.

Carium and CareDirections announce a commercialized version of StrokeCP, a post-discharge management system for stroke survivors that was developed by Atrium Health Wake Forest Baptist.

Microsoft unbundles Teams from Office globally to address anticompetitive regulatory pressure. The company added Teams to its business software suite in 2017 and saw its usage soar in the pandemic’s early days, triggering a Slack complaint to the EU three months before Slack sold itself to Salesforce for $28 billion.

Change Healthcare has not updated its cyberresponse page since March 27. Its dashboard shows 117 of Optum’s 137 applications remain down from the February 21 cyberattack.

Government and Politics

The US Coast Guard hopes to finish scanning paper medical records into its MHS Genesis / Oracle Health system by the end of the year, but in the mean time, it is advising service members that obtaining medical records copies will take longer.

Other

Epic will probably never top the sheer cleverness or sassiness of its years-ago April Fool’s post in which it claimed to have changed its name to EPIC since people mistakenly all-caps it regularly, but this year’s spoof was pretty good:

• Epic gets construction approval for the Barbie Dream House campus.
• The company is chosen as the official EHR of “Grey’s Anatomy.”
• A recipe for a carrots and wings dish called Roots & Wings, which is a subtle reference to Judy’s charitable foundation Roots & Wings that will get the proceeds of her Epic shares.
• My personal favorite – MyHeart, a dating app that uses MyChart messages and patient history to suggest romantic matches based on clinical factors.

Sponsor Updates

• Ascom launches RemoteWatch, a remote monitoring service for the Ascom Healthcare Platform designed to help hospitals proactively identify technical issues before they impact patient care.
• Findhelp and Uber Health support patients beyond the four walls of a medical office.
• Censinet offers NIST Cybersecurity Framework 2.0 enterprise assessments, which include support for compliance with HHS Healthcare and Public Health Sector Cybersecurity Performance Goals.
• Artera adds dashboards for patient engagement benchmarking and no-show revenue recovery estimates to its Harmony Analytics solution.
• Spok’s mobile clinical communications software earns the top ranking for customer satisfaction for the seventh consecutive year in Black Book Market Research’s recent survey of 7,000 end users.
• Waystar extends its Accelerated Implementation Program through April to help healthcare organizations process claims in the wake of the Change Healthcare cyberattack.
• CereCore publishes a new e-book, “In Sync with Care: The Future of Clinical IT Service Desks.”
• Arrive Health sponsors the Health Evolution Summit April 3-5 in Dana Point, CA.
• QGenda, Wolters Kluwer, Elsevier, SnapCare, Symplr, and Care.ai will exhibit at AONL 2024 April 8-11 in New Orleans.
• AvaSure publishes a new Use Case Spotlight, “Expand the Reach of Care Teams with Virtual Nursing.”
• Clearwater names Jackie Mattingly (Coker Group) senior director of consulting, small and medium hospitals.
• The Pinnacle Take Podcast features Direct Recruiters Managing Partner of Health IT and Life Sciences Mike Silverstein, “A Network of Friendlies.”

Blog Posts

• Six Cybersecurity Points Healthcare CIOs Should Explain to Their Boards (CereCore)
• Capturing Medical Necessity in Ambulance Coding (AGS Health)
• National Doctors’ Day: Three Altera clinicians share their perspectives on designing for clinicians today (Altera Digital Health)
• SATRE: Standardised Architecture for Trusted Research Environments – Information Governance (Arhidia Informatics)
• The Referral Process: Closing the Loop on Patient Care (Artera)
• Introducing Availity’s Mission Moments Series (Availity)
• 10 Work Comp Did-You-Knows (Bardavon)
• The Making Care Primary Model: How it is revolutionizing primary care (CarePort Health)
• Takeaways from HIMSS24 (Dimensional Insight)
• Separating the Hype from the Hope in Healthcare AI Trends for 2024 (DrFirst)
• Boosting Billing Efficiency with the Clinical Rule Engine (EClinicalWorks)

Contacts

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

Morning Headlines 4/2/24

Solventum Begins Trading on the New York Stock Exchange

Solventum, a 3M spinoff that includes health information systems among its four business segments, begins trading on the NYSE.

Walmart Health Clinic Expansion On Track For 70 By Year’s End

Walmart will open 22 new health clinics within Walmart Supercenters this year, bringing its total to 70 across the country.

New Valley Hospital ready to welcome patients with state-of-the-art tech

New Jersey-based Valley Health System will open a new hospital in Paramus equipped with smart beds, bedside infotainment systems, and AI-powered fall-prevention technology.

Curbside Consult with Dr. Jayne 4/1/24

I’ve spent the last couple of weeks catching up on some reading, after my library “hold” list went rogue. I typically keep several dozen books on hold but in a frozen status so that I sit at the top of the wait list and can release them when I’m ready.

For some reason, a cluster of them released unexpectedly, dropping on top of my already planned reading. Unfortunately, at my library there isn’t a way to send a book back to the hold list once it’s in transit, unless you want to start over at the end of the line. I dutifully picked up my books and dug in for some intense reading, since you can’t renew them if others have them on hold and I wanted to make sure I was able to read them all. One of the books was “The Chaos Machine: The Inside Story of How Social Media Rewired Our Minds and Our World” by Max Fisher.

Being in healthcare and taking care of adolescents, teenagers, and young adults, I’m acutely aware of the impacts social media has had on these groups in recent years. Even before the societal disruptions of the COVID pandemic, research tied use of social media to sleep issues, which are in turn associated with depression, memory issues, and poor school performance. As we became physically isolated during the pandemic, many young people turned to social media to fill the void, with varying results. In many communities, cyberbullying has been on the rise, and concerns about social media have increased to the point where the US Congress is stepping in.

“The Chaos Machine” is full of meticulous details, many of which are pulled from interviews with Silicon Valley executives, social media experts, gaming experts, academics, and those who have been negatively impacted by social media. It references scholarly works, court records, and other primary sources that tell a story that most of us can’t even fathom. Given the subtitle, I expected it to dig heavily into the physical and psychological impacts on individuals with the concept of world impact as an abstract. I’ve read about the impacts on social media on US politics but wasn’t aware of many of the details the book provides about how the technology has directly impacted other countries, such as Myanmar and Brazil.

Parts of the book are difficult to read, including descriptions of online mobs threatening whistleblowers with violence ranging from swatting to rape or murder. Even more difficult to read are the descriptions of indifference by social media executives when confronted with evidence that their products are causing harm. Surprise, surprise, internal Facebook documents from 2018 reveal that systems were intentionally designed to deliver “more and more divisive content in an effort to gain user attention & increase time on the platform.” The book covers the rise of medical misinformation on social media and some of its harms, but having been a frontline physician, it doesn’t really explain the magnitudes of harm that we see when people use social media for medical advice.

Especially interesting was the description of the growth of Silicon Valley, comparing it to the Galapagos Islands as far as providing a unique evolutionary environment for technology development. However, instead of the isolation leading to the development of unique animal species, it led to “peculiar conditions” that “produced ways of doing business and of seeing the world that could not have flourished anywhere else – and led ultimately to Facebook, YouTube, and Twitter.” I see some of the same conditions in healthcare IT, where people still believe that you can just throw money at problems and somehow they’ll get solved, and where the people calling the shots often have only a rudimentary understanding of how healthcare is delivered in the US.

The book takes a walk down memory lane, talking about strife that took place in 2006 as Facebook introduced its News Feed. It was one of the first documented episodes of internet outrage becoming action, complete with protesters and the side outcome of dramatically expanding user engagement. “The Chaos Machine” covers the so-called casino effect, where social media platforms use the human dopamine system to hook users with intermittent variable reinforcement. It chronicles the rise of social media “like” buttons, which provide additional reinforcement through validation from other users.

I don’t’ want to give away the rest of the book, but I think it’s worth the read. I would recommend it for anyone who is trying to raise children in this crazy world and who thinks it’s OK to just let them play on a parent’s phone or that it’s a good idea to help a child falsify their age to obtain a social media account.

I met a new neighbor whose children attend a Waldorf school, which holds the philosophy that “exposing children to computer technology before they are ready (around 7th grade) can hamper their ability to fully develop strong bodies, healthy habits of discipline and self-control, fluency with creative and artistic expression, and flexible and agile minds.” In thinking about adolescent patients, I’m supportive of this stance, although I know that for parents it’s a nearly impossible battle unless the rest of the “village” around your child is similarly aligned. In thinking about some of the adults I know, it might have been a good idea to keep them away from social media even longer because they’re apt to behave badly even though they’re of age and should know better.

The book was a fairly quick read, as well as something different from my recent binge reading of murder mysteries and detective novels. Next on the list are two novels from Stacy Abrams, followed by chef Iliana Regan’s memoir “Burn the Place.” I enjoy reading about strong and determined women who have made their mark in industries that aren’t supportive. If it’s a good read, her second book “Fieldwork: A Forager’s Memoir” also threw itself out of my rogue hold queue. After that will be “Symphony of Secrets” by Brendan Slocumb, which I’m auditioning for a potential book club selection. If you’re in a book club with a sassy CMIO, you might want to hold on reading that one for now just in case.

What kind of books do you read when you have free time? Or do you accumulate a list or stack that you might never make it through? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/1/24

U.S. Attorney Announces $3.1 Million False Claims Act Settlement With Radiology Company And Its CEO For Fraudulent Billing Practices

Teleradiology vendor The Radiology Group pays $3.1 million to settle False Claims Act charges that its US-based radiologists rubber stamped draft image interpretations that were performed by India-based contractors who are not licensed in the US.

QuickMD Expands Healthcare System with Acquisition of Project Recovery

Telemedicine provider QuickMD acquires South Dakota-based addiction treatment clinic Project Recovery.

Hume AI Announces $50 Million Fundraise and Empathic Voice Interface

Hume AI, which has developed an emotionally intelligent voice interface for AI chatbots and other digital applications, raises $50 million from a spate of investors that includes Northwell Health’s venture capital arm.

Monday Morning Update 4/1/24

Top News

Atlanta-based teleradiology vendor The Radiology Group pays $3.1 million to settle False Claims Act charges that its US-based radiologists rubber stamped draft image interpretations that were performed by India-based contractors who are not licensed in the US.

Highlighted in the complaint is Radiologist A, who signed more than 10,000 reports in a single month, approved drafts in as little as 16 seconds, and did not check the “critical” tag when it was indicated.

The company notes on its technology page that all of its software is powered by AI.

Reader Comments

From Bollinger’s Band: “Re: Oracle Health. You mentioned Larry’s age and his cheerleading for the former Cerner. They may be re-architecting the former Cerner offering and that will let them come roaring back.” I don’t see that happening, for these reasons:

• A key reason that Cerner was getting kicked out of hospitals was fallout over its deficient RCM product and its “solution” of rolling out a spiffed-up Soarian offering.
• I don’t think that most hospitals that moved to Epic did so because of Cerner’s architecture, so Oracle’s whiz-bang technology may not prove to be competitive differentiator.
• Epic is so far ahead of Cerner in customer KLAS rankings that Oracle Health will never catch up. I don’t see Oracle making the huge investment that would be needed to make their product more competitive.
• Layoffs and attrition has likely caused a big loss of industry knowledge at Oracle Health, and putting a bunch of hotshot technologists in charge of a complicated, industry-specific critical application has never worked that I can remember.
• They’re not getting all those former customers back from Epic, so there’s nobody left to sell to. The only potential greenfield is outside the US, and product localization is always a challenge even for more focused vendors.
• The DoD business isn’t as lucrative as it sounds since Cerner wasn’t the prime contractor, and the VA may or may not ever get widely enough implemented to unleash the gravy train.
• Oracle paid way too much for Cerner and expresses near-embarrassment about its latest jewel in every earnings call. Customers were already sprinting for the Epic door, and raising prices or lowering costs to increase margins to “Oracle standards” will only hasten the exodus.
• Oracle Health is lucky that the company is printing money overall from its cloud business and that Larry Ellison is still enamored with it. At some point, Safra is going to get tired of making excuses for Larry’s plaything, at which time Oracle could strangle it financially or sell it for parts, such as the government business. The Larry-funded Project Ronin had noble aspirations, but was shut down without notice in early March.

HIStalk Announcements and Requests

Most of us who have posed health inquiries to an AI tool were just Dr. GPTing, but two poll respondents took its answer to their doctor who changed their advice or orders as a result.

New poll to your right or here: What single factor would be most attractive in considering a change of employers? I recognize the urge to check more than one option, but pretend you are reading a job posting – what would get your attention first?

Here’s a bonus survey, as suggested by a reader. What single, realistic first step would you take to improve US healthcare outcomes, cost, and accessibility? You get one sentence.

Webinars

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

Announcements and Implementations

A study finds that patients who were forced by their employer to switch to a high-deductible health insurance plan were more likely to experience diabetes complications.

Other

DrFirst gets the April Fool’s jump on Epic in rolling out the Magic Med Mash-Up, which squashes all your individual pills into one big capsule. Paging Martin Shkreli for the Daraprim play.

Sponsor Updates

• Vyne is recognized as a Becker’s Top RCM Company in 2024.
• Optimum Healthcare IT adds Mike Jackman (Leidos) to its boards.
• PerfectServe announces several 2023 milestones, including awards and recognition from industry analysts, 10% revenue growth, and a 107% enterprise net customer retention rate.
• QGenda will exhibit at AONL 2024 April 8-11 in New Orleans.
• WellSky launches a Medicare Certified Home Health certification for clinical teams.
• SnapCare and Incite Strategic Partners partner to provide clinical workforce solutions for the senior living and senior care segments.
• Waystar publishes a new e-book, “4 opportunities for healthcare revenue cycle improvement.”
• Wolters Kluwer Health launches Lippincott Ready for NCLEX to help prepare nursing students for the National Council Licensure Examination.

Blog Posts

• Aligning for change: Driving quality performance and risk management with AI (Notable)
• Population Health and the Power of Data (Netsmart)
• Five Proven Strategies to Improve Operating Margins: Part One: Optimize the Healthcare Workforce for Retention and Cost Savings (QGenda)
• The Rise of AI in Healthcare IT & Implications for Hiring Strategies (Revuud)
• Congratulations to all award winners recognized at HIMSS24 (Rhapsody)
• Reducing Pharmacy Costs with Innovative Enrollment Technology (RxLightning)
• Patient experience: the hospitality effect in healthcare (Sonifi Health)
• Helping Healthcare Heal Itself Starts with Collaboration (Surescripts)
• 5 Ways That Outdated On-Call Scheduling is Hurting Your Hospital (Symplr)
• The Outdated Practice of Security Questionnaires in Healthcare – Moving Towards a Real-Time Approach (VisiQuate)
• Revolutionizing Clinical Data Exchange: Healthcare Innovation 2024 Innovator Award Winner (MRO)

Contacts

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

Morning Headlines 3/29/24

US offers $10 million bounty for info on ‘Blackcat’ hackers who hit UnitedHealth

The US State Department offers a $10 million reward for information leading to the Blackcat ransomware group that hijacked Change Healthcare’s systems last month.

YC-backed Pelago, a virtual clinic for addiction treatment, raises $58M Series C

Virtual addiction clinic Pelago raises $58 million in Series C funding, bringing its total raised to $151 million.

Walgreens Boots Alliance Reports Fiscal 2024 Second Quarter Results

Walgreens beats Q2 revenue and earnings expectations, but reports a $5.8 billion impairment charge related to its VillageMD primary care business, which will close another 160 locations versus the previously planned 60.

News 3/29/24

Top News

An Optum dashboard shows that 115 of the 137 Change Healthcare applications remain down 37 days after the company was hit by a cyberattack.

Reader Comments

From Former Epic: “Re: Epic. There has always been a board of directors, which includes outside directors from the community. Judy has voting shares (51%) but the foundation has the stock cash value. The family will be comfortable, but not Walton or SC Johnson wealthy. The foundation will sell stock back to the company to distribute donations. No public sale.”

From Diatom: “Re: disruption. Three technologies could disrupt health services delivery – surgical robotics, AI-powered drug discovery and development, and FHIR as a technology enabler for innovators. However, I share your skepticism about technology’s potential. We will continue to have a low-value, intervention-based system unless we change our agricultural policies, education policies, taxation and subsidies, and cultural habits related to food and work-life balance. Also, even if technology could significantly improve healthcare delivery, it wouldn’t necessarily reduce the cost of our system, which is one of its greatest travesties. Blockbuster drugs and robots aren’t cheap.”

Webinars

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

Acquisitions, Funding, Business, and Stock

Walgreens announces Q2 results: revenue up 6%, EPS –$6.85 versus $0.81, beating expectations for both. The loss includes a $5.8 billion impairment charge related to its VillageMD primary care business, which will close another 160 locations versus the previously planned 60. The company said when it invested $5.2 billion in VillageMD in 2021 that it planned to open 1,000 new locations by 2027 – VillageMD had 230 practices in 15 markets then — and that it expected the standalone VillageMD to conduct an IPO in 2022. From the earnings call:

• CEO Tim Wentworth says that US customers are seeking value due to inflation, depleted savings, and record household debt and delinquency, so its drugstore division is investing in key value items and pushing its own brands.
• The pharmacy group’s outperformance was led by its vaccine portfolio.
• VillageMD has issues with slower than expected patient panel growth, multi-specialty productivity, and Medicare payment changes.
• The company has decided not to follow through on plans to create a new pharmacy technology platform and instead will modernize its existing systems, leading to a $455 million impairment charge for software and development assets.
• The company will review its businesses and recommend to the board that they be sold if they don’t offer growth opportunities, with that work to be presented at the end of April.

Wound imaging vendor Spectral AI announces Q4 results: revenue down 13%, EPS –$0.22 versus –$0.13, beating expectations for both and valuing the company at $35 million. The company’s income came entirely from government research contracts, as commercial product sales launched in Q1 2024.

Toronto-based Healwell AI, which pivoted to AI-powered disease detection and changed its name from MCI Onehealth Technologies, announces Q4 results: revenue down 37%, EPS -$0.10 versus –$0.05. Shares are at $0.90, valuing the company at $129 million.

Financially teetering Steward Health Care sells its physician network to Optum pending government approval.

Sales

• Sutter Health chooses Abridge for drafting visit notes from encounter audio.

Announcements and Implementations

Five9 announces GenAI Studio, which allows organizations to apply off-the-shelf generative AI models such as OpenAI and customize them for use in their contact center.

Government and Politics

ONC releases the draft of the 2024-2030 Federal Health IT Strategic plan for public comment.

Privacy and Security

In England, computer systems at the University of Cambridge’s medical school remain down a month after an apparent cyberattack. The university’s systems previously went offline for a short time on February 19 from a hacker group’s DDoS attack.

in Scotland, hackers post sample data from the several terabytes they claim to have stolen in last week’s ransomware attack against NHS Dumfries and Galloway. 

Experts say that the technology of startup HeHealth, which claims that its app can diagnose sexually transmitted infections from penis photos, is a “privacy disaster.” The company – whose tagline is “your intimate bestie for unprotected sex” — markets one product variation as a sexual wellness tool for women, who are encouraged to submit photos of the genitals of their prospective partners in claiming to have their permission. Forbes also notes that the system was trained on just five conditions but the company lists 10 that it can diagnose, also determining that the source of the app’s reference data is free Internet pictures and those that early participants were required to provide. TechCrunch observes that most STIs are asymptomatic and calls out company disclaimers that its results should not be considered medical advice, with the author adding, “You should not take a picture of anyone’s genitals and scan it with an AI tool to decide whether or not you should have sex.”

Other

Eight physicians from Israel’s Hadassah Medical Center apparently didn’t bother to read their own radiology article, which contains nonsensical ChatGPT output, before submitting it for publication. The piece appears in Elsevier-published Radiology Case Reports, an open-access journal that charges authors $550 to run whatever they submit. Elsevier notes that 80% of submitted articles are accepted and are posted online in an average of 19 days, which isn’t exactly a bragging point given this example. The authors ignored publication guidelines that require that any use of AI to be disclosed as a footnote. Surprisingly, the uncorrected article remains online. Thanks for reminding everyone that you can’t count on clinicians to catch AI’s mistakes.

Sponsor Updates

• Findhelp’s Customer Success Division delivers 30 bags of food and hygiene items to the little free food pantry at Padron Elementary School in Austin, TX.
• Availity announces a comprehensive suite of technology solutions and services designed to assist health plans and providers with achieving compliance with the CMS Interoperability and Prior Authorization Final Rule.
• Experity will exhibit at SPUC 2024 April 3-6 in Norfolk, VA.
• FinThrive releases a new Healthcare ReThink Podcast, “Trailblazing the Next Generation of Healthcare Analytics.”
• Healthcare IT Leaders releases a new Leader to Leader Podcast, “Transforming Community Health.”
• Inovalon supports the California-based Integrated Healthcare Association’s Align, Measure, Perform Program with its Converged Quality quality measurement and improvement solution.
• Laudio will exhibit and present at AONL 2024 April 8-11 in New Orleans.
• Medhost will exhibit at the Texas Organization of Rural & Community Hospitals Spring Conference April 1-4 in Dallas.

Blog Posts

• 3 ways professional societies can boost impact through collaboration (Elsevier)
• Reflecting on HIMSS 2024: Key Takeaways from Orlando (FinThrive)
• Four Healthcare Contact Center Trends in 2024 (Five9)
• Hidden Signs of a Healthcare Data Breach (Fortified Health Security)
• Healthwise Education is Best in KLAS 2024! (Healthwise)
• Transforming Healthcare: The Benefits of Digital Image Sharing (MRO)
• Adding Stability Through Outsourcing in a Chaotic Healthcare Delivery Market (Impact Advisors)
• A fresh outlook on brain health (Linus Health)
• AI for Cancer Detection: A New Dawn in Healthcare (Lucem Health)
• How EHRs Elevate Rural and Community Nurses (Medhost)

Contacts

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

EPtalk by Dr. Jayne 3/28/24

I attended a recent online forum focused on a telehealth topic. I was surprised to find that some of the participants really didn’t understand the idea of a virtual-first practice. The only way they could conceptualize it was as part of a brick and mortar organization. When I started talking about ordering labs from services that would come to the patient’s home or using patient-provided data from connected devices, I got some blank stares.

The participants were from large health systems and other well-established organizations. I wonder if they’re outliers in their organizations or whether there is really a lack of interest in trying to deliver care outside of traditional office-based settings. Being able to offer services like that isn’t just about convenience. It’s also about serving patients in remote areas and helping those who have other reasons they can’t leave their homes. I hope they take the ideas back to their organizations for discussion.

I receive a ton of marketing emails and spammy-sounding connection requests on LinkedIn. It’s guaranteed that I won’t accept your request if you use made-up words to try to sound cutesy about the serious problems facing physicians today. Case in point: one vendor positioned their product as “the cure for documentitis and physician burnout.” It went on to further define “documentitis” as “inflammation caused by burdensome documentation requirements imposed by EMRs, billing systems, etc.” I’m sure their marketing folks thought it was amusing, but it shows a complete lack of regard for the true causes of documentation fatigue, including out of control regulatory requirements, expanding quality measurement, and lack of regard for the professionals in the system. As someone making purchasing decisions, this kind of messaging takes a company to the bottom of my round file.

Another one of my pet peeves seemed to be everywhere this week — the presence of large microphones in front of the participants on conference calls. I sympathize with the need to have clear audio and to want to use nice equipment, but when you’re a healthcare professional communicating with other healthcare professionals, it’s important to remember that you’re not a DJ and this is not a podcast. The majority of people I take calls with use integrated laptop microphones, earbuds, or something higher tech but unobtrusive, and they sound just fine. I’m hoping this was just a freak occurrence this week and it’s not a new trend. However, as a licensed amateur radio operator, I’ve got some solid options to put into play if it does become the hot new thing.

One of my favorite readers sent me an article about AI nurses, referring to the idea as “cray-cray.” The phrase has been added to the Oxford Dictionary, so I’m not afraid to quote it. The premise on AI nurses is that they’re designed to deliver non-diagnostic nursing care, such as education, which would help mitigate the ongoing nationwide nursing shortage. The idea was dissected recently in The Hustle, which offered some interesting commentary, including the fact that the hardware needed to run such an offering isn’t cheap.

I would add to that the fact that nursing is regulated by the states and licensure is required, so it’s going to be a hard sell that this is actually nursing care versus something else. Organizations will have to look closely at quality metrics that have been shown to be improved through effective nursing education, such as readmission rates, and understand whether AI-delivered education will meet the mark or cause other downstream consequences.

Speaking of potential unintended consequences, I was glad to see a recent article that looked at whether the hospital at home movement could be a double-edged sword. Although positive outcomes have been reported in the literature, such as reduced costs and improved patient experience, some areas haven’t been fully researched. I’ve talked about some of these in the past, including equity and the fact that patients with lower socioeconomic status might not have a caregiver in the home or a safe home environment compared to those in higher socioeconomic categories. The article brings up the idea of safe storage of medications, availability of food particularly in areas that are food deserts, and the ability to safely store meals that may be delivered in advance. Reliable and cost-effective utilities may also be an issue in some situations, as is the presence of broadband for communications and device connectivity.

The comments section on the article brings up additional points. One commenter who used RN in her name described it as “just a fancy earlier discharge scenario. We already have post-ops shoved out the door half awake, unable to dress themselves and throwing up the whole way home. What a crazy, cruel system we have created.” Another referred to the concept as “quite the pipe dream given today’s realities and limited resources.” Another commenter with experience as a home health RN noted, “I have been in extremely low income homes that were kept in immaculate condition and were exceptionally clean and have been in other homes that were in extremely well to do neighborhoods that were so dirty on the inside that I had concerns with even placing my bag on the floor.” That’s an interesting point and creates an additional burden on organizations to ensure suitability of the environment regardless of its ZIP code or other identifiers. I’d be interested to hear from organizations who are already managing hospital at home to understand how they assess potential care environments and what percentage of candidates are deemed suitable once there is a deeper dive.

I’ve always been interested in public health, so I was glad to see the US Food and Drug Administration publish information on egg safety for those who celebrate spring religious holidays such as Easter and Passover. Salmonella is always a concern where eggs are involved, and the press release offers tips on safe handling, cooking, and storage. Deviled eggs are a staple for family gatherings in our family, but I do enjoy the holiday clearance aisle at Target for all my post-Easter cravings.

What’s your favorite springtime food? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/28/24

Goodbill raises $2M and expands customer base to unearth and challenge medical billing errors

Goodbill, a Seattle-based startup that has developed software that detects medical billing errors, raises $2 million.

InStride Health Raises Oversubscribed $30 Million Series B to Expand Access to Best-In-Class Specialty Treatment for Pediatric Anxiety and OCD

Tech-enabled pediatric mental healthcare provider InStride Health announces a $30 million Series B funding round.

New Federal Health IT Strategy Sets Sights on a Heathier, More Innovative, and More Equitable Health Care Experience

ONC seeks public comment on the draft “2024-2030 Federal Health IT Strategic Plan” so that federal agencies can better align their health IT policies, programs, and investments.

Healthcare AI News 3/27/24

News

OpenAI files a trademark application for a voice engine and digital voice assistants, possibly signaling that the ChatGPT developer plans to complete with Apple’s Siri and Amazon’s Alexa voice assistants.

An official with the Congressional Budget Office says that AI could reduce healthcare costs by identifying patients who could benefit from early treatment, but it could also increase costs by spurring the development of beneficial but expensive technologies or identifying more patients who need treatment.

Business

Amazon will invest another $2.75 billion in generative AI startup Anthropic, which it had already backed with $1.25 billion, valuing the maker of the Claude chatbot at $18 billion.

Healthcare business process technology vendor Sagility acquires BirchAI, which offers AI-powered call center technology.

Tennr, which use AI to extract and route data from faxes, raises $18 million in Series A funding.

The London-based non-profit Institute for Public Policy Research makes a worst-case prediction that AI could eliminate 8 million jobs with no gain in gross domestic product. The authors predict that a Phase 2 of AI implementation in which AI is allowed to execute tasks could affect financial workers, shop owners, and IT managers, while advancing to Phase 3 – where processes are built around AI and people accept interacting with avatars – could transform the work of teachers, doctors, and hospitality workers. They recommends creating policies that protect tasks where human involvement is valued, consider imposing wealth taxes or social security assistance, and raising taxes companies that replace people with AI.

Research

NIH provides funding for Treatment.ai to develop a culturally sensitive AI approach for collecting family medical history. The company says that approaches for collecting medical histories for African-American families are biased because they do not adequately capture information about blended families, non-traditional relationships, and the lack of patient information about the health of relatives.

Researchers find that AI can successfully design new drugs to overcome bacterial resistance.

ChatGPT generates discharge documents for orthopedics case that are comparable in quality to those that are created by junior orthopedic surgeons and orthopedics residents, but 10 times faster. Interestingly, while reviewers found hallucinations in four documents that ChatGPT created, that was fewer than the six that were found in the physician-generated notes.

A West Virginia University School of Pharmacy study will look at using AI to collect patient medication information from clinical and billing systems, including clinician notes, to help with medication reconciliation and to determine the risk of readmission.

Other

The National Bureau of Economics Research publishes a grant-supported book titled “The Economics of Artificial Intelligence: Health Care Challenges” that analyzes barriers – incentives, management, data availability, and regulation – that will impact the efficiency and cost disruptions that are possible in the 20% of the US economy that involves healthcare.

Contacts

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

HIStalk Interviews Kelly Boyd, SVP/GM, Sonifi Health

Kelly Boyd, MBA is SVP and general manager of Sonifi Health, the healthcare division of Sonifi Solutions of Sioux Falls, SD.

Tell me about yourself and the company.

I’ve been working in healthcare technology for about 20 years. The bulk of that time has been in product development and operations. I have spent time with the customer success and sales aspects.

Sonifi Health is a wholly owned subsidiary of Sonifi Solutions. Our parent company serves hospitality and other commercial markets. Sonifi Health focuses exclusively on the healthcare market. Within Sonifi, both the parent company and our subsidiaries, we have an underlying theme that our goal is to simplify the delivery and operation of technology so that our customers can accomplish all that’s possible when technology works. Technology is great, but it needs to complement the organization where it’s being deployed. Our role and our goal is to simplify that process, make it seamless, and make it valuable to the organizations that deploy it.

We still fundamentally align ourselves with the Triple Aim initiative that was launched by IHI back maybe 2007 and later modified to the Quadruple Aim. We want to enhance the patient experience, improve health outcomes, and drive operational efficiencies. That translates to both cost reductions and staff satisfaction. That is where we live. All of our technologies — smart room technology, staff technologies — are built fundamentally to go after those initiatives. 

You emphasize that healthcare is hospitality. Do you think that most hospitals see it that way and invest accordingly?

I do. We’ve doubled down on this, because in technology and healthcare tech, we can get so caught up in technology itself. The hospital’s mission is patient care, and at the root of that is compassion, comfort, and health outcomes. That essentially is the real meaning of hospitality.

We have launched with that messaging, both to remind ourselves internally and also message to our clients that we get that technology doesn’t exist for technology’s sake. At the end of the day, everything that we are doing is about the human experience. Creating an environment that is comfortable to the patient and that reduces anxiety has a direct impact on outcomes.

Patients aren’t necessarily capable of judging the clinical aspects of the care that they receive. Does the hospitality aspect of their stay carry an outsized importance in their perceived satisfaction?

It’s interesting, because patients aren’t able to perceive different levels of true clinical care. They can attribute that “I survived that surgery, therefore it was good,” but they can’t really assess where that surgery ranked on the spectrum. What they can definitively create is the perception about how they felt were treated and the hospitality side of the care that they received. People can articulate those things more than they can the true clinical aspects of healthcare.

Patients sometimes complain that technology, such as a physician charting in the EHR, is distracting. How do they see in-room technology and smart rooms?

There is no downside to the technology from the patient perception side. We have seen bumps in hospital patient experience scores simply from bringing in smart room technology. Patients translate high tech, cutting edge, state-of-the-art automation technology to better care. Whether that is a fair translation or not, it happens.

People are human, and investments on the hospitality side impact our perception of the quality of care that we are going to receive. Is my room nice? Is the furniture nice? Is the TV nice? Anything that a hospital does to to move to a smart room to enhance the environment impacts the patient’s perception of their quality of care, and to some extent, how they will perceive their outcomes.

Your website cites a study that found that patients who use an interactive, in-room system are more likely to also use it to follow education recommendations. How can hospitals use that finding?

We found that the entertainment side of it draws people into the system. You want to watch that movie, listen to the music, engage with spiritual content, or whatever those entertainment pieces are that bring the patient into the system. The system is then designed to capitalize on the fact that the patient is engaged with the system.

We will strategically prompt the patient to engage in their care as well. That can be learning about their condition, how the recovery will go once they go home, things that they should watch for once they leave the hospital, and what they need to do to plan and prepare for their discharge. We leverage the entertainment side as a way to pull the patient in, but once they’re in the system, you have all kinds of opportunities to put the important information in front of them.

Do you engage family members in that process?

We love involving family members. When you’re a patient, there is a little bit of anxiety. You’re unsettled. Your ability to grasp the information is much different than a family member. We encourage the family members. We know that the the information lands and and sticks a little bit better when the family members are the ones participating, especially when you’re talking about young children or the adult caregivers of their elderly parents. The family members play a big part of it.

As a parent, I’ve been in the hospital with my kids and I was starved for information. What’s next? What should I expect when I take my son or daughter home? We see a lot of engagement with family members with the system.

How will patient engagement technologies be used outside the four walls of hospitals, such as with hospital at home or virtual hospitals?

This is a trend based on initiatives to reduce costs. It’s clear that the more comfortable the patient is, the better healing, recovery, and outcomes that you’re going to see. The challenge for everybody in healthcare — healthcare tech providers, payers, all of that — is educating patients across the board on health literacy, recovery, lifestyle changes, behavior, and all those things. Companies like Sonifi are trying to increase the engagement and activation of patients so that they can be successful in a home care or hospital at home environment.

How widely are hospitals using digital signage and way-finding?

Most hospitals have some type of digital signage in play. There is a need to continue to get information into the hands of patients and visitors. This could be population health content, where you have people sitting in waiting rooms and have an opportunity to get the right controlled messaging content in front of patients and family members. Signage is everywhere. There’s a lot with branding and marketing of the health system’s mission and vision.

With way-finding, you’re talking substantial institutions that exist on campuses and multi-building setups, where they are trying to make it easier for patients to navigate the campus and get where they need to go.

For Sonifi, we have the nationwide field service organization. We are already providing technology, the breadth and depth of our knowledge of infrastructure, and these type of messaging tools. This becomes a complementary solution for us that we can deliver alongside our more clinical applications.

What are your thoughts about having worked for the same company for nearly 30 years?

When it comes to Sonifi and Sonifi Health, I really love the people that I work for. We’re based in the Midwest, so we have an organization of people who are really committed and care. That “Midwest nice” thing really comes through with the group. I have people in my team who have been here 30 years as well. I have people who have been here 15 years and they joke that they’re the newbies. 

The group believes in what we do. They care about the patient. They care about the the nurse and the clinician. They care deeply about the operations person who is trying to run and manage the distribution system. Everybody is behind what we’re doing, which makes it easy to come to work every day and makes it easy to stay and commit with the organization.

What factors will be important for the company over the next few years?

We are tracking the movement away from inpatient new construction dollars to the outpatient side, with more short stay-focused, hospital-led home initiatives. Interoperability, security, data exchange, and seamless experiences across multiple facilities are big on our radar as well.

Morning Headlines 3/27/24

Brightside Health Raises Strategic Series C, Welcomes Trip Hofer to Board of Directors

Virtual mental healthcare company Brightside Health announces a $33 million Series C investment, bringing its total raised to over $107 million.

Sagility Acquires BirchAI, a GenAI Company in the Healthcare Space

RCM and business process engineering company Sagility acquires BirchAI, a startup that offers AI-powered call center automation technology.

Tennr Raises $18M in Series A Funding

Tennr will use $18 million in Series A funding to further develop and market its AI-based document automation software geared towards providers who rely on digital faxing.

News 3/27/24

Top News

Masimo considers spinning off its consumer business, which includes personal health and audio products, while retaining its healthcare and telehealth solutions.

Reader Comments

From Disingenuous: “Re: Judy Faulkner’s giving pledge. It’s shallow since she’s giving her share of Epic to a foundation that will still have majority control, someone who will carry on her legacy and maintain her vision from the grave.” I read that years ago, thinking that the question then becomes who’s on the foundation and how it interacts with a company that has always had one focused leader who is also the majority owner. Epic has always had a board, I hear, although I know nothing about its members and level of control.

From Psych MD: “Re: VA OIG’s report. The report identifies quite a few problems with the patient’s follow-up mental health care, but using root care analysis leads organizations to identify a single failure among several, to recommend corrective actions even when it seems likely that they would not have affected the outcome, and in this case looks to the EHR as a source of blame or a magical fix. I don’t know why root cause analysis has become ascendant over FMEA or other approaches to optimize care and safety.” The full VA OIG report puts a lot of blame for the patient’s death — which was not determined to be a suicide even though the patient had a history of suicidal ideation — on Oracle Health, but these points seem relevant:

• The EHR failed to issue the VA-specified number of staff reminders to schedule new behavioral health appointments for no-shows or cancellations. 
• The patient had changed their phone number and didn’t respond to appointment scheduling messages.
• The VA contacted family members, who told them the patient was doing OK and didn’t provide the new telephone number, at which time the patient’s flag for being at high suicide risk was turned off, which prevented ongoing suicide prevention reach-outs.
• The patient died of cardiac arrhythmia after using inhalants, of which they had a documented history but denied current use, two months after their most recent visit. 
• This  complex case resulted in some EHR changes involving missed appointments, but the patient was not cooperative despite VA employee efforts and no evidence exists that any changes would have improved this patient’s unfortunate outcome.

From AT: “Re: Epic’s succession plan. What’s yours? I’m hoping that you will post an obituary. My career and even my passion for health IT are forever indebted to everything you have provided me and the entire industry.” I appreciate that, but I want no part of limelight, prehumous or posthumous, for doing what I consider an empty-room hobby. You probably won’t even notice my bucket-kicking absence anyway since Jenn can keep the news coming until existing sponsorships expire and the site can go gracefully dark without stiffing anybody (no pun intended).

HIMSS24 Comments Review

Several folks have said it will be hard for HIMSS / Informa to figure out what needs fixing about the annual conference based on the comments that I received. I’ll take the counterpoint in summarizing the list as being mostly minor and personal gripes, with few underlying themes that indicate mass, irreparable dissatisfaction. My thoughts:

• Attendance and exhibitor count are the ultimate benchmark. Those were just fine for HIMSS24. Informa isn’t forced to rescue a conference whose relevance and reach has slipped beyond repair.
• HIMSS20 and the HIMSS23 carpet debacle soured a lot of people on HIMSS, so hopefully Informa’s acquisition cost reflected the value of the tarnished jewel and the company has the vast experience that is needed to improve it. It also means that Hal Wolf has relinquished a lot of power to Informa, which his critics will celebrate.
• HIMSS conference educational presentations and keynotes mostly draw yawns, but HIMSS can improve those now that Informa is managing the exhibit hall logistics.

My suggestions:

1. Steal ViVE’s “refreshments and meals included” idea, although that will be hard to scale up to a HIMSS-sized conference due to physical space limits. Requiring highly paid executives to fight for space to sit on dirty carpeted floor to dribble dressing from their $20 salad on themselves instead of networking with fellow attendees is absurd. If money is the problem, sell $50 daily vouchers for access to a private area near the exhibit hall that offers food (including fresher and healthier options) and coffee for most of the day, an expanded model of the now-dead HIMSS Bistro offering that I have always thought worked really well when I paid for a ticket. The other limitation here is that convention centers impose their monopoly powers on F&B to charge astronomical prices, such as $73 for a gallon of Starbucks coffee and $29 for a boxed sandwich or salad in Orlando, all plus a mandatory 21.5% service charge plus tax. 
2. Dial back the chirpy influencers and HIMSS Media cheerleading unless the target audience is non-decision makers who like that sort of self-aware gushiness. 
3. Limit the conference to three days and keep the exhibit hall open during all show hours. Nobody enjoys the last-day ghost town, and HIMSS could save money on facilities and let people get back to work by declaring that three days is enough. HIMSS25 will do exactly that, although HIMSS26 sees the return of Tumbleweeds Friday.
4. Get better keynote speakers, schedule them early in the week, and announce them before attendance decisions have already been made. Pay one celebrity speaker, if you must, who packs star power while knowing and caring nothing about the work of audience members (hello, Nick Saban), but otherwise get non-vendor insiders on the big stages.
5. Take advantage of ViVE’s weak spot of high registration fees by using HIMSS clout to lower them, attracting more provider-siders. That won’t necessarily stem the C-level migration from HIMSS to ViVE, but could correct the inflated vendor-provider ratio and draw in health system directors, managers, and clinicians who have influence on technology decisions but who have limited travel money. I would argue that HIMSS can do fine without CIOs since they rarely emerged from their HIMSS VIP sequestration to hit the show floor anyway.

Webinars

March 27 (Wednesday) 3 ET. “Houston Methodist: Deploying clinical AI at scale for improved outcomes.” Sponsor: Health Data Analytics Institute. Presenters: Khurram Nasir, MD, MPH, chief of cardiovascular disease prevention and wellness, Houston Methodist DeBakey Heart & Vascular Center; Brenda Campbell, RN, senior consultant, HM Health System Innovations; Nassib Chamoun, MS, founder and CEO, HDAI. The presenters  will share how an interdisciplinary team collaborated to successfully use predictive models and a novel AI-driven approach to address post-discharge mortality. They will also describe how they expanded use of the platform to reduce clinician time spent digging through the EHR with a one-page risk profile, including codes extracted from notes using generative AI, and targeting their highest risk patients for extra attention. They will speak to how they overcame barriers to bringing AI at scale to support clinicians across the care continuum.

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

Sales

• Nebraska Medicine will implement EVideon’s Vide Health smart room technology within its Innovation Design Unit.
• The Medical University of South Carolina will implement Flatiron Health’s Flatiron Assist oncology clinical decision support software at its cancer center.
• Prisma Health will extend its use of Bamboo Health’s Pings, Spotlights, and Discharge Summaries across its organization and InVio Health Network.
• Samaritan Health Services (OR) will provide virtual urgent care services via Epic MyChart from KeyCare.
• Children’s Hospital Los Angeles offers Nabla’s Copilot AI assistant to its pediatric specialists following completion of a pilot project.
• Community Health Network (IN) will use Ferrum Health’s reference AI architecture to deploy radiology algorithms.

People

CompuGroup Medical will promote Benedikt Brueckle to US CEO in January 2025. He will take over from Derek Pickell, who will retire at the end of this year.

Heather Dunn, MBA (Vanderbilt University Medical Center) joins The SSI Group as president.

Collette Health names Christine Gall, DrPH, MS, BSN (Gall Consulting) chief nursing officer.

Announcements and Implementations

OhioHealth Van Wert Hospital goes live on Epic as part of a system-wide transition that was first announced in early 2021.

Black Book Research announces winners of its awards for highest hospital user satisfaction and clinician satisfaction, as determined by 14,000 respondents.

Malaysia’s health ministry says that it will rejuvenate Selayang Hospital’s Cerner EHR, which was the country’s first paperless system, that has deteriorated to the point that the hospital went back to paper.

Amazon expands its same-day prescription delivery, which is already offered in five cities, to New York City and Los Angeles. The company also notes that it is using AI behind the scenes to prepare prescriptions for pharmacist review to increase efficiency.

A study by The Clinic by Cleveland Clinic finds that its virtual second opinions save the patient or their payer $8,705. Two-thirds of its second opinions recommend a change in diagnosis or treatment, while 85% of patients who had been told that they needed surgery were instead recommended an alternate treatment. The $1,850 program includes a video call with an RN, concierge collection of medical records, and referral to a Cleveland Clinic expert who provides a written second opinion.

A new KLAS report on clinical communications interoperability concludes that no vendor connects consistently across all use cases — which include communication with outside physicians; integration with staff scheduling; timely alert and alarm routing; integration with EHRs, dietary, and transport systems; and communication of after-hours needs — but deep adopters are starting to unify their communications.

Government and Politics

Senator Mark Warner (D-VA) introduces the “Health Care Cybersecurity Improvement Act of 2024.” If passed, the bill will enable eligible providers to receive advanced and accelerated payments in the wake of a cyberattack, provided they and, if applicable, third-party vendors meet certain cybersecurity standards. Warner launched the Senate Health Care Cybersecurity Working Group last November.

Privacy and Security

Petersen Health Care, one of the country’s largest nursing home operators, files bankruptcy due to a double whammy of cybersecurity incidents — an October 2023 ransomware attack that delayed bills and then the Change Healthcare cyberattack that reduced receivables. The company operates 90 nursing homes in the Midwest and reported $340 million in revenue in 2023.

Other

UK HealthCare’s Chandler Hospital (KY) opens a new ICU floor equipped with remote patient monitoring technologies, including bedside patient engagement software from GetWell and video monitoring from Caregility.

Forbes Hospital (PA), part of the Allegheny Health Network, will equip a 47-bed unit with smart patient room and virtual nursing technology in the coming weeks.

Sponsor Updates

• EClinicalWorks becomes a HRSA-approved EHR vendor for UDS+ submissions.
• Availity and Bamboo Health will exhibit at the State HIT 2024 Connect Summit April 1-4 in Baltimore.
• Divurgent publishes a new success story, “Divurgent Consolidates Over 120 EHR and IS Applications After Hospital Acquisition.”

Blog Posts

• Addressing Epic EHR Support Gaps When Resources are Scarce (CereCore)
• How Happy Are You at Work? (AdvancedMD)
• HIMSS 2024 – Key Takeaways: Let’s Hear from Lenny! (Agfa HealthCare)
• The Win-Back: ApolloMD Learns There’s No Match for AGS Health’s A/R and Coding Services (AGS Health)
• Going on offense: Filling the gaps in healthcare cybersecurity (Altera Digital Health)
• How the zero-copy data lake will advance modern healthcare and data (Arcadia)
• Social Determinants of Health Tools: Context in Communications (Artera)
• Understanding the Change Healthcare Breach and What It Means for Your Healthcare Organization (Clearwater)
• Black Box for the Medical Industry Provides Unprecedented Data (Dimensional Insight)
• Retaining Excellence: Strategies for Keeping Top Talent in the Healthcare Technology Industry (Direct Recruiters)
• Generative AI Integration into the EHR – Welcome to the Healthcare Revolution (EClinicalWorks)

Contacts

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

Morning Headlines 3/26/24

Arches Medical Partners Acquires 11 Primary Care Practices in Rhode Island

Walgreens-owned VillageMD sells its 11 primary care clinics in Rhode Island to Arches Medical Partners, which owns IPA-focused software company New Era Medical Operations.

Responding to Change Healthcare, Warner Introduces Legislation to Protect Providers in the Event of Future Hacks, Requiring Minimum Cybersecurity Standards

Senator Mark Warner (D-VA) introduces the “Health Care Cybersecurity Improvement Act of 2024,” which, if passed, will enable eligible providers to receive advanced and accelerated payments in the wake of a cyberattack.

Masimo plans to spinoff consumer business

Masimo considers spinning off its consumer business, which includes consumer health and audio products, and retaining its healthcare and telehealth solutions.

Curbside Consult with Dr. Jayne 3/25/24

This weekend was targeted on catching up on some journal articles and making a continuing education plan for the next couple of months. I’ve got some new projects I’m working on that are a little bit outside my comfort zone. I know from experience that unless I make a formal plan to dig into the topics and stick to their plan, there’s a high likelihood that I’ll get pulled into firefighting projects for my clients and will never get done with the reading I feel I need.

Part of today’s effort was to read through all the articles that I’ve bookmarked in the last couple of weeks because I find them interesting, clearing them off the digital reading pile. It was a good cross section of topics and I think readers might find it interesting to see what’s on the reading list of a free-range clinical informaticist.

There were several articles from the Journal of the American Medical Informatics Association, with most of the ones I found interesting arriving in the most recent issue. The first addressed “Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs.” This topic resonated with me since I spent a good chunk of my training at an academic medical center in a city that served a particular refugee population that grew dramatically in the span of a few years.

The authors hypothesized that in-person interpreters are “particularly beneficial for these patients” but underused, and set out to use predictive analytics to identify the patients who should be prioritized for interpreter services. They performed semi-structured interviews with stakeholders to understand what those caring for patients thought about the idea.

I’m a big fan of qualitative research. Although one can gather a lot of information from surveys that elicit specific data points, some of the best understanding I’ve gained on complex issues has come from direct conversations with those who are involved in the issue. Stakeholder analysis is frequently overlooked when organizations are scoping large complex projects, and my feeling is that organizations neglect it at their own peril since it’s an excellent way to identify those who will support your project and those who are likely to block it. The key is having interviewers who are neutral and trusted, and making sure that people feel comfortable sharing their perspectives.

The authors conducted 49 stakeholder interviews and identified significant risks that would need to be addressed, including accuracy, privacy, and supply / demand issues. They also identified benefits including the ability to overcome clinician bias and to empower interpreters. Those are sentiments that you can’t always ascertain from a checkbox.

Another article that caught my attention also dealt with machine learning, this time looking at ethical perspectives on algorithm development for healthcare. The study also included qualitative research, interviewing 10 machine learning researchers on the topic. The participants were unanimous in identifying the ethical significance of algorithm development, which is good.

Not surprisingly, they identified areas where ethics may need to play a larger role, including around “standards related to scientific integrity, beneficence, and justice that may be higher in medicine compared to other industries engaged in ML innovation.” I haven’t read a truer sentence in some time, and it resonated with me after being at HIMSS and hearing some of the things that vendors were saying about artificial intelligence and machine learning. It’s amazing that companies still think that solving the healthcare problem can be done in the same ways that they have solved various problems in other industries. The last two decades have been littered with companies that thought that they had all the answers, but ended up exiting the healthcare space quickly.

A third article looked at whether patients who read visit notes have a higher rate of so-called “closing the loop” on recommended testing and referrals. The authors set out to look at “the relationship between patient portal registration with/without note reading and test/referral completion in primary care.”

For those of you who haven’t spent time in the primary care trenches, the primary care physician is essentially on the hook to make sure that patients complete every recommendation and referral that they are given. Even if the patient says “no” and state that they have no intention of completing a recommended action, the fact that they don’t is reflected in various clinical quality measures and also can come back around and bite the physician in the event the patient has a poor outcome.

I’ve been involved in medico-legal cases where the physician clearly recommended a test and the patient clearly refused it, but fast forward to when the patient has a preventable harm and the usual allegation is that the physician should have tried harder to get the patient to comply.

The article looked specifically at colonoscopies, which are of course recommended for early detection of colorectal cancer. They also looked at dermatology referrals for suspicious skin lesions and cardiac stress tests. They looked at whether patients who used the patient portal and who had read at least one visit note had more timely completion of the tests compared to patients who had portal accounts but didn’t read notes and compared to patients without portal access.

The authors found that compared to patients who had no portal access, those who had accounts had 20% higher chance of closing the loop on recommended tests. When patients had accounts and read at least one note, the odds were 40% higher. The authors controlled for various social, demographic, and clinical factors, but concluded that there are still gaps that must be addressed when recommendations are left incomplete. They recommend increasing efforts to promote patients accessing their notes, as well as other patient engagement strategies to ensure that patients complete recommended diagnostic and preventive steps.

Having done a fair amount of work in the space, the latter is certainly a lofty goal. There are so many reasons that patients may not complete recommended testing. These include but are not limited to: perception of the importance of the test; insurance coverage for and/or the cost of the test; time needed to be off of work or to secure childcare; understanding of the preparation needed for the test; difficulties in scheduling; and transportation issues. The list goes on and on.

I’ve worked on campaigns to address the issue through patient portal messages, texting with chatbots, integrated voice response systems, old-school 1:1 phone calls, postcards, letters, community outreach, health fairs, and more. Each little bit drives the needle, but there is still much work to be done.

I still have a stack of articles to read, but I felt like I at least made a little progress today. What’s on your list for continuing education topics? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Countdown Begins: When Will Your Health System Say Goodbye to Traditional Faxing?

The Countdown Begins: When Will Your Health System Say Goodbye to Traditional Faxing?
By Tim Hoskins

Tim Hoskins is VP of solution architecture at Vyne Medical of Dunwoody, GA.

For 145 years, copper wire has been essential in facilitating communication across America, providing seamless nationwide connectivity through the telephone network. However, in 2019, the Federal Communications Commission (FCC) prompted the modernization of this infrastructure by discontinuing the mandate for local phone companies to maintain copper wire services and lifting price cap requirements for customers.

This policy shift led to significant changes in America’s communication networks, forcing the transition of traditional plain old telephone services (POTS) to more advanced systems. Despite this change, some essential services and organizations — including healthcare providers and payers — still use on-premise fax systems. These traditional systems are reliant on the aging and soon-to-be-obsolete copper wire infrastructure. 

To continue providing exceptional patient care, hospitals and health systems that still use traditional fax need to revamp operations and replace their outdated systems. Without this essential update, they risk the inability to efficiently exchange crucial patient information, including referrals, prior authorizations, lab results, and prescription orders.

In cities nationwide, the transition away from copper wire has already begun, and given the substantial costs associated with upkeeping and repairing copper wires, it is welcomed by many. “The copper infrastructure is old, expensive to repair and maintain, and can’t support high-speed Internet connections,” shared Fraida Fund, a research assistant professor at NYU Tandon’s Department of Electrical and Computer Engineering. “Fiber is technically a much better medium for communications; you can transfer data faster over fiber than over copper.”

During severe storms or unexpected line outages, many hospitals and health systems have already experienced the dilemma of not being able to rely on their system’s traditional phone and fax systems, presenting a significant communication challenge for both providers and patients. In 2012, Hurricane Sandy damaged copper lines across New York City, and instead of repairing the lines, fiber optics were installed in their place.

“We lost dial tone on my fax line, so I couldn’t receive or send any faxes. Imagine my patients waiting for their CAT scans, X-rays, their reports of blood, all different kinds of things,” explained Ida Messana, MD, a Queens internist who specializes in geriatric medicine.

Despite its high costs and inconsistent reliability, traditional faxing remains prevalent in healthcare systems nationwide. In 2023, it was estimated that:

• 75% of healthcare still depends on fax.
• 47% of small hospitals and 43% of rural hospitals are most likely to mail or fax medical records.
• On average, a 500-bed hospital loses more than $4 million due to communication deficiencies.

“The problem is abandoning customers in rural areas and small towns who have few if any, choices for broadband,” explained Matt Larsen, CEO of Vistabeam.

As rural health systems navigate this transition, these organizations must advocate for their staff and patients by proactively seeking out replacement solutions to overcome the unique challenges they may encounter.

Cloud fax technology provides a convenient digital faxing solution, removing the need for traditional copper wire transmission within health systems. Beyond resolving the reliance on copper wires, cloud fax brings a host of benefits that can optimize operations and enhance patient care.

When selecting the ideal cloud fax vendor, it’s important to acknowledge that not all vendors are equal. While many provide digital faxing services, the benefits they offer vary greatly. Innovative companies that are eager to collaborate and integrate with an organization’s existing technology can not only address the copper wire dilemma, but also generate time and money savings with a healthcare-centric solution that can provide:

• Outbound faxing for the EMR system.
• Real-time and encrypted exchange networks.
• Remote access capability.

As communication methods evolve, both rural and urban health system technology must adapt accordingly. With solutions available that enable seamless bidirectional cloud faxing, the reliance on copper wire for essential operations can be eliminated. Additionally, the need for printing and scanning is minimized, empowering teams to efficiently manage large volumes of sensitive and urgent communications.

The transformative power of cloud technology in healthcare management is evident in its ability to replace traditional faxing and safeguard patient care from unforeseen disruptions. When one medical center that uses cloud fax technology experienced an incident in their server room, the patient access team feared they would lose their missed incoming faxes. However, following the repair of their server, the inbound fax orders became immediately accessible, highlighting the reliability of cloud-based systems in maintaining seamless operations despite unexpected interruptions.

“That would have been 607 patient orders lost if they weren’t in the cloud. Everything lives in the cloud. Thank you for the cloud!” shared the team’s patient access manager.

As healthcare communication continues to evolve, it’s imperative to equip teams with the right tools to maintain exceptional patient care.

Readers Write: The Vulnerability Few Anticipated

The Vulnerability Few Anticipated
By Darcy Corcoran

Darcy Corcoran, MBA is principal consultant for cybersecurity at CereCore of Nashville, TN.

This healthcare IT security organization takes their job seriously. They secure perimeters, restrict IP addresses from their network (even for IPs that falsify their country of origin), multifactor authenticate access, and protect administrative login credentials. Their access controls are mature and have proven reliable. They’ve thought of everything, right?

Then why were hired hackers able to find their way onto this organization’s network in less than four hours?

It started with something so simple, so seemingly innocuous – and so convenient for so many – that no one even questioned it until the day they learned why they should.

Patient Advocate Olivia wants the best for patients and diligently works to do her part to create great patient experiences. That’s why when she realized that patients needed to contact several departments in the hospital to schedule appointments, ask billing questions, and find out where to park for an imaging appointment, she asked to have a link to the employee directory added to the website. Website Manager Liam added the link right away because he, too, is devoted to patients and wants to make their journey easier.

Days later, he was pleased to see site analytics that showed a few uses of the link. An easy mission accomplished.

Soon after, IT Director Mary received findings of her team’s latest cybersecurity external threat assessment, which alerted her to a publicly available website resource that showed first names, last names, departments, and phone numbers for key employees of the hospital – the employee directory. She acted quickly to have the directory restricted from the website, and network monitoring tools verified that there was no related suspicious activity to investigate.

Why did Mary take such swift action? The information in an employee directory, while convenient for some use cases, contains everything a malicious actor needs to begin a small to large-scale attack by doing any of the following:

• Contact the IT helpdesk to reset a user password or redirect the multifactor authentication to the hacker’s phone number, enabling them to reset the account password manually and gain access to the network.
• Contact the IT helpdesk, impersonating a provider to social engineer information with the aim of figuring out the helpdesk authentication techniques and procedures to better defeat the authentication processes in the future.
• Gather employee lists and emails that allow the hacker to continue to harvest credentials to engage in password spraying and brute force attacks that would assist in gaining access to a user level account or privileged user account.
• Contact a patient as though they are a facility employee in need of personal health information for an upcoming appointment.
• Contact a patient as though they are a member of the facility’s billing department in need of credit card or other information to process a payment
• Contact employees in hopes they will divulge additional seemingly innocuous but powerful information when it’s in the wrong hands, such as email format and locations.
• Gain physical access to the facility.

The people and organization in this story are fictitious, but the vulnerability depicted is a common one. Stories like these help us appreciate how cunning malicious actors can be and how little they need to know to learn more and wreak havoc. It also demonstrates how protecting the organization is difficult and getting harder, given all of the potential vulnerabilities and the numerous gaps to address. Organizations where boards and stakeholders understand, support, fund, and do their part to defend have the best chance in an environment where hackers are looking for their next opportunity.