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EPtalk by Dr. Jayne 1/27/22

January 27, 2022 Dr. Jayne 1 Comment

ECRI has released its 2022 list of Top 10 Health Technology Hazards for hospitals, medical practices, and home health organizations. Cyberattacks are at the top and no one should be surprised by some of the others on the list: supply chain limitations, insufficient emergency stockpiles, and issues with disposable gowns and inadequate barrier protection. The fact that we’re still dealing with some of these issues in Year Three of the pandemic is a travesty. My local nurse friends keep me apprised of the personal protective equipment situations at their various hospitals. At one hospital, it has only been in the last two weeks that there have been enough N95 respirators available so that medical/surgical nurses can have a fresh respirator every shift. Previously, they were limited to one per month. One can’t help but wonder whether the fact that so many nurses were out with COVID infections played a role in opening the supply cabinets.

Nearly every industry has been impacted by the labor shortage, and healthcare is no exception. An article published at the end of 2021 in Mayo Clinic Proceedings: Innovation, Quality & Outcomes looked at “COVID-Related Stress and Work Intentions in a Sample of U.S. Health Care Workers.” The study looked at 20,000 workers across more than 120 organizations, surveying them between July and December 2020. The authors found that burnout, increased workloads, and concern about infection were associated with plans to reduce work hours or leave the field entirely. The presence of anxiety or depression were also associated with those plans, as was a higher number of years in practice. Nurses had the highest intention to reduce work hours followed by physicians and advanced practice providers. Surprisingly, administrators had the lowest intention to reduce hours.

I was in a conversation recently with early career physicians who were contemplating changes to their workloads. Both women and men in the discussion were eager to learn more about nontraditional practice opportunities including job share arrangements or part time work. Considering the physicians I’ve worked with over the years, the proportion of physicians who view medicine as a calling and who are willing to make great sacrifices for their careers is shrinking. While some view this as an erosion of professionalism, others view it as a healthy acceptance of reality by people who are navigating challenges that previous generations could not have envisioned.

Based on the survey results, nearly one-third of physicians, advanced practice providers, and nurses intended to reduce their work hours. Ten percent of physicians and 20% of nurses intended to leave practice entirely. The authors note that feeling valued by the organization was protective, lowering both the intention to reduce hours and the intention to leave. They conclude that additional research is needed to determine whether mitigation strategies can prevent a healthcare workforce crisis. In speaking to physician and nurse colleagues alike, many are looking for tangible changes to improve working environments. These include improvements to staffing ratios, expanded access to employer-sponsored childcare, and protection from workplace violence. It would benefit administrators to work on these issues in depth rather than continuing with their ineffective strategy of pizza parties and challenge coins.

Maybe they can take advantage of the $103 million that the Department of Health and Human Services has allocated to reduce healthcare worker burnout. The funds are part of the American Rescue Plan and will be granted to organizations serving providers in underserved and rural areas. Over $28 million will go to programs to promote mental health and well-being, $68 million will go towards burnout reduction and resilience, and the remaining $6 million will be used to create the Health and Public Safety Workforce Resiliency Technical Assistance Center. Most of the burned-out healthcare workers I know are tired of hearing the word resilience, so maybe they can think of something else to call the Center.

In telehealth news this week, the US Court of Appeals for the District of Columbia Circuit ended efforts by telehealth provider RemoteICU to obtain Medicare coverage for services rendered by virtualist physicians outside the US. The company had alleged that an emergency rule allowing Medicare to pay for critical care services via telehealth extended to physicians outside the US. The judicial panel stated that RemoteICU “failed to present its challenge in the context of a specific administrative claim for reimbursement of services” and failed to meet the criteria laid out for judicial review of Medicare claims. As always, the devil is in the details where Medicare is concerned.

I had several people reach out to me regarding the EHR performance issues I wrote about earlier this week. I checked in with my colleague this afternoon to see how things were going after his vendor’s interventions. Despite the changes, the organization continued to have issues with sluggish chart loads and delays in rendering various screens, but it seemed better overall. A couple of times a day, the system would come to a screeching halt, though. With additional eyes on the issue, they identified a potential cause they hadn’t captured previously. Because of changes in childcare schedules, a worker who typically handles billing processes at night had been working during the day. She had no idea that the processes she was running were resource-intensive since she had always worked nights and no one had ever mentioned it. Her supervisor was similarly unaware, working during the daytime.

Once that was addressed, performance stabilized, and although the crushing delays had stopped, the system was still slower than was ideal. Average chart load time was improved by about 50%, though, so the users were borderline ecstatic per his report. The performance team has continued to make various adjustments in an attempt to improve things further, but they’re trying not to make too many changes at once, which is prudent given everything the organization has been through. I wonder what they’re doing for the rest of their clients who might also be struggling with volume-related challenges, and whether the improvements made for this organization will be propagated to others proactively or only when things become dire.

Is your technology team proactive or reactive? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/27/22

January 26, 2022 Headlines No Comments

DigitalOwl raises $20M to analyze medical records for insurers

DigitalOwl, which uses natural language processing to extract relevant, searchable data from medical records, raises $20 million in a Series A funding round.

Defense Department Deploys New Health Records System for Another 19,000 Users

In its largest MHS Genesis go-live to date, the DoD deploys its new Cerner EHR at 100 locations in Texas.

Seattle startup Atlas Health raises $40M to connect health systems with philanthropic aid for patients

Atlas Health raises $40 million to further develop software designed to help patients find medical financial aid.

HIStalk Interviews Eric Rosow, CEO, Diameter Health

January 26, 2022 Interviews No Comments

Eric Rosow, MS is co-founder and CEO of Diameter Health of Farmington, CT.

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Tell me about yourself and the company.

I’ve been in healthcare tech for about 30 years. I’m a co-founder of Diameter Health, along with John D’Amore, and I serve as the company’s CEO.

I started my career as a biomedical engineer with Hartford Healthcare. I’ve always been drawn to solving problems that are at the intersection of tech and healthcare delivery. What I especially love is being part of building, and helping to build, mission-driven, high-performance teams. Our mission at Diameter is simply to make data universally accessible, organized, and actionable for better health and more efficient healthcare. 

We have been at this for almost 10 years and we stay focused on this core capability, which we call upcycling. We have been able to process clinical data and patient records for nearly half the country across multiple market segments, including payers, federal and state governments, HIEs, life insurers, and HIT partners. The common thread across all these folks and partners is that they all recognize the challenges and complexities of wrangling multi-source, multi-format raw clinical data that is often dirty, inconsistent, and incomplete.

Has wider use of technology building blocks such as FHIR and APIs exposed the problem of data that falls short in quality, usability, and interoperability?

We are excited about FHIR and the standards that it brings to offer a much more efficient means to exchange data and to pull data. In our early days, we thought of data as digital, but it is like crude oil. It’s in the ground, in tanks, and in trucks. It’s digital, but it’s crude. We look at the market in three broad segments. We need pipes to move and aggregate the data. We need the refinery to clean up and enrich that data. Then we need to address the use cases where you need high octane fuel to run different engines, whether it be a moped or an F-16.

FHIR makes the pipes much larger and puts a lot more pressure behind it, so it is amplifying the need for cleaning up the data. We think that’s a critical challenge that people are seeing now. FHIR is amplifying the understanding of how dirty the data is in terms of incompleteness, duplication, and just plain old dirtiness.

What did you think of the recent study that found that even sites that use the same interoperable EHR can’t necessarily exchange data?

That’s the driver of why this company was founded. I was moved years ago at the HIMSS conference by hearing Google’s Eric Schmidt give a keynote where he talked about how healthcare has this compelling need for a second tier of data. He concluded that these primary data stores of EHRs have to be supplemented, not replaced, with that second tier. He went on to emphasize that in his 40 years being in enterprise software, he has seen this phenomenon repeat itself over and over.

That’s exactly what is happening today in the interoperability landscape, and frankly, what is needed. It’s also super exciting because the second tier of data can unlock massive opportunities for innovation, better workflows, and better outcomes.

To give you a real-world example of a second tier of data, we all use and benefit from apps that use GPS coordinates, such as Uber, Lyft, Waze, and Apple and Google maps. None of those apps would work if GPS locations were inconsistent, because you can only have one set of coordinates for a given location. In healthcare, we literally have hundreds of ways in which diagnoses like CHF, or COVID status, or lab values like HbA1c, even from the same EHR, are inconsistent and are unable to be exchanged. We feel that it is critical to let these innovators and developers focus on innovating and not the dirty work of normalizing data. Once you can do that, then AI and machine learning algorithms work superbly at scale when they can ingest clean data.

How can we improve healthcare when we look at dirty data, when 80% of the allergies are not coded appropriately — and we’ve found in our work that 30% have no code at all — 70% of lab results don’t use the right vocabulary, and almost half don’t use LOINC? We’ve also found that over 40% of medications don’t have the right coding to run quality measures. That is ubiquitous and why this is such an important field that we are so committed to.

What business models are being created or improved with the wider availability of healthcare data?

As I look back at our journey for almost a decade, it has been following the data. We went after the health information exchange market in 2014. Willie Sutton said that he robbed banks because that’s where the money is, and in our case, that’s where the data was. We wanted to go there, not just because they had Epic, Cerner, Meditech, Athenahealth, or Allscripts, but they had over 100 certified EHR vendors. 

Cutting our teeth at that foundational area where all the data is being aggregated has been so valuable. The experience and scar tissue that we developed during those few years allowed us to expand into other markets, including the VA, payers, HIT vendors, and even life insurance, which wasn’t a market we were thinking a lot of before COVID. But it’s an interesting example of how you can have one core capability that crosses multiple markets and therefore multiple use cases and business opportunities.

The early goal was for hospitals to be able to exchange data, but now many players are creating data that should be part of a longitudinal patient record. Is technology adequate for creating that patient record from sources such as pharmacies, urgent care centers, and insurers?

If I go back to my analogy of pipes, refinery, and use cases, our rebranding to what we call upcycling data is where it all comes together. It’s all about powering innovation, efficiency, and better outcomes across the ecosystem, but it fundamentally comes down to the data quality.

I once had the honor of being introduced as a speaker by Micky Tripathi before he took his role at ONC. Knowing how dirty and incomplete clinical data is, Micky introduced me as “the sewage treatment guy.” I laughed, but I took that as a badge of honor, like Mike Rowe in the series “Dirty Jobs” crawling through sewer pipes with rats on his head. Cleaning up this data, upcycling data, can indeed be a dirty job, but it’s so important. It’s not easy, but it’s so necessary to do it at scale. Turning all that potential from the disparate sources into power is to enable these downstream use cases is key.

What level of data exchange is happening between insurers and providers?

COVID has certainly put a highlight on that ability with life insurance, for example. Efficiently accessing and utilizing clinical data coming out of the EHR supports more cost-effective and timely underwriting. Because in a world of COVID, people could not literally go into healthcare settings and pull charts and scan charts. They realize that this is an opportunity. We’ve done some exciting work with Swiss Re, the world’s largest reinsurance company, that sees that not just as a US opportunity and challenge, but a global one. The data interoperability landscape is so exciting right now, but all these technologies are challenged by solving the big opportunities around the data.

But it’s also confusing. A lot of companies are describing capabilities using a lot of the same language. That’s where we wanted to come up with a different way of how to position and explain that. The pipes, as I call them, are going to continue to be more and more commoditized. FHIR will drive more and more ability to access data. The real challenge is in how to make it usable and actionable. That’s why we are excited by this notion of upcycling, because I think it can transform the industry by having that clean, precise, clear data to run these downstream use cases.

Much of the expense of healthcare is administrative, such as in prior authorizations where the clinician’s eyes on the screen and hand on pen or keyboard become the insurer’s EHR interface. Do you see the systems of providers and insurers being connected to meet each other’s needs electronically?

I do. Value-based care is really is the only way forward, but you have to align the incentives and the risks. You have to accurately measure and quantify outcomes that can be enabled with respect to access, quality, and cost. So, we need to be really clear by what we mean by and how we measure value. At the same time, as you look at this co-opetition of pay-viders, that new model or new business paradigm that can save money and be more efficient for one cohort is taking away the revenue and the profitability of another. There’s always going to be an inherent aversion, in the short run, to change from one business model to another. But in the long run, this journey is going to be Darwinian, in that individuals and organizations have to evolve or risk declining or going away altogether.

Should those who are holding useful healthcare data be paid to share it?

I think they should. That is what defines value. If you, as a payer or a provider, have to spend hundreds of thousands of hours to clean up that data and make it actionable, then it will be worth the cost and the value that comes from that. This whole notion of a clinical data optimization enablement that can leverage today’s API architecture is really what is foundational to enabling these new use cases. But the devil is in the detail, and it’s easy to talk about but so hard to do.

To make it the data valuable so that people are willing to pay for it, you have to do a number of things. You have to semantically normalize the data to national standards. You have to enrich it with metadata through streamline analytics. You have to reorganize it so it can be found in the expected clinical sections of a document. Then most importantly, you have to duplicate it and summarize it back into that longitudinal comprehensive record that you mentioned.

I’ve talked with so many clinicians and I’ve heard things like, “If you give me a 70-page CCD, it’s like 68 pages too long.” Or, “If you give me eight CCDAs for a patient, I’m not going to look at any of them.” That’s where the value is going to come. If you can save a busy doc time, then it’s worth it and I think people will pay for it.

I’m not a clinical informaticist, but I’d love to give you an example of why I think this can be so challenging and also so beneficial. Let’s say you have a patient show up and their record indicates that they’ve been prescribed the brand name drug Vicodin.That could either come across in the machine-readable or the human-readable portion of the document. The first thing you need to do is recognize that that brand name Vicodin is a combination medication of acetaminophen and hydrocodone.Then, you need to compute and reevaluate so that each ingredient can go into the respective RXNorm codes.

This all gets back to prior auth and how you need the right data to make the right decisions. After that, you have to leverage clinical grouping standards and indicate that hydrocodone is an opioid agonist and map that to the NDF-RT, the National Drug File – Reference Terminology. Finally from there, you can add on another meta-tag to indicate the severity of that medication in the case of hydrocodone, or Vicodin by transitivity. You can indicate that this medication is in fact a Schedule II controlled substance. All of this needs to happen to this transparent process.

If you can do that while maintaining visibility and data provenance, you have so much power. For example, you can make a query from a single field in a given state or region say, “Show me everyone within that region, or across the state, that’s been prescribed an opioid.” You can do that from a single field by having that metadata layered on top. Not just doing it for drugs, but for allergies, labs, immunizations, vitals, procedures, and demographics. That’s the opportunity. That gets back to that second tier that Eric Schmidt spoke about to enable all these different downstream use cases and business models.

How will the move to the cloud affect the possibilities?

It absolutely enables innovation and speed to value. It most certainly amplifies the network effect of propagating new knowledge and best practices. We are certainly seeing that across our customer base. I recall reading an interview that you did sometime not too long ago where one of your interviewees made the analogy that on-prem is like waterfall software development, whereas cloud is more agile, lean, and creating minimally viable products. That’s where the cloud has been so exciting, knowing that it can be secure, HITRUST and HIPAA compliant, and people can access that data and share that data securely anywhere. In our case, all of our clients, except a few that require an on-prem environment, are in a hosted environment in the cloud.

Where do you see the company in the next few years?

There’s a lot of interesting opportunities going forward. We’re going to continue to see a tremendous amount of data continuing to come in at exponential rates. I like to look to the future by looking back, and I’ll just share with you what I think might be of interest to your readers. When John D’Amore and I co-founded this company, we had this common vision to address and focus on what we believe is the biggest barrier in healthcare, data quality and usability. We heard of a physician named Larry Weed, a professor from the University of Vermont Medical Center. There’s this incredible YouTube video of him presenting a grand rounds lecture at Emory University over 50 years ago.

Dr. Weed so eloquently spoke to how the patient record cannot be separated from the caring for of the patient. The record is the patient, and that is the practice of medicine. He goes on to say how patient care is intertwined and how important the complete longitudinal record is in determining what the clinician does in the long run. So even 50 years ago, before the adoption of Meaningful Use and the proliferation of EHRs, Dr. Weed had the humility and the perception to recognize how the human mind simply can’t carry all that information without error. 

He also made that cautionary prophetic statement that we’ll either be a victim of poor data quality or we’ll triumph because of it. As we look at the volume of data, two-plus years into a pandemic, this is a hauntingly accurate prophecy. Enabling data in the largest industry in our economy to be actionable, accessible, and organized has never been more important. We are super excited about what the future holds in terms of continuing to improve data quality.

There has never been a more exciting time to be immersed in this world of healthcare IT, and in particular, data quality, or as Micky would say, sewage treatment. It has been an exciting journey. Working with such a special team has been so rewarding. I’ve always believed that the greatest product an entrepreneur can create is other entrepreneurs and leaders. As a rowing coach and a former coach and a rower, I would love to conclude with an analogy that I love being in this Diameter Health boat, being part of a crew that works so hard for a common goal. I can think of no goal more important than transforming healthcare and the ecosystem by enabling better healthcare with better data.

Morning Headlines 1/26/22

January 25, 2022 Headlines No Comments

Reimagine Care Secures $25 Million in Series A Funding to Drive Commercialization of Home-Centered, Value-Based Cancer Care

Reimagine Care, which supports at-home cancer care with remote patient monitoring and patient-reported outcomes, raises $25 million in a Series A funding round.

Change Healthcare is said to consider asset sales in UnitedHealth deal

Change Healthcare is considering selling some of its assets to help gain approval for its sale to UnitedHealth Group, with payment integrity business ClaimsXten being shopped at a potential $1 billion sale.

Golden parachutes could make parting sweet sorrow for Cerner executives

Cerner President and CEO David Feinberg, MD and former chairman and CEO Brent Shafter will receive a combined $43 million if they are forced out as a result of the Oracle acquisition, according to recent SEC filings.

News 1/26/22

January 25, 2022 News 6 Comments

Top News

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Cerner lists the Golden Parachute Compensation that will be paid to its top executives if they are forced out in the Oracle acquisition:

  • President and CEO David Feinberg $22 million (company tenure – less than four months)
  • EVP/CFO Marc Erceg $11 million (company tenure – less than one year)
  • EVP/CTO Jerome Labat – $11 million (company tenure – 19 months)
  • Former Chairman and CEO Brent Shafer — $21 million
  • Four other Cerner executives will potentially benefit from the change-in-control terms of their contracts.

Cerner’s SEC filing also provides a timeline of Oracle’s acquisition offer:

  • Rumors of unsolicited take-private acquisition offers arose in May and June 2021.
  • Cerner turned down a private equity sponsor’s request for acquisition discussion in July, an offer that was repeated and again denied in August 2021.
  • Oracle made its initial inquiry on October 7 and due diligence followed.
  • Oracle made a $92 per share offer on November 12.
  • Cerner’s board  discussed opening up the sale process to private equity buyers on November 20, but worried about long timelines, the risk of information leaking out, price uncertainty, and losing Oracle as a buyer. They also expressed concern that the deal size would require the participation of a consortium of private equity buyers that would complicate the sale process. They ruled out contacting potential strategic buyers for the same reasons plus a concern about “the potential lack of interest.”
  • Cerner told Oracle that its per-share offer was too low on November 24, Oracle said it needed Cerner’s board to be specific about the price it sought, and Cerner gave a price of “the upper $90’s” on November 29.
  • Oracle offered $95 on December 1. A Cerner executive was rebuffed when trying to increase the offer price, with Oracle saying its price was its “best and final offer.”
  • Cerner received an email inquiry from a potential strategic buyer on December 17, but was operating under an exclusivity agreement with Oracle through December 20.
  • No other potential bidders expressed interest after the Wall Street Journal reported the proposed Oracle acquisition.
  • The board listed the risks of continuing to run Cerner as a standalone company as (a) competition and healthcare market challenges; (b) operating and product risks in a rapidly changing technology environment; (c) increased competition; (d) retention of key technical employees; (e) risks in government contracting; (f) hitting growth targets in foreseeable market conditions with few attractive acquisition targets to boost growth and enter new markets; (g) the risk of not hitting growth and profit targets; and (h) uncertainties around COVID-19’s impact on the company’s business.
  • Terms of the merger agreement allow Cerner to consider unsolicited better offers.

Webinars

February 9 (Wednesday) 1 ET. “2022 – Industry Predictions and Medicomp Roadmap.” Sponsor: Medicomp Systems. Presenters: David Lareau, CEO, Medicomp Systems; Jay Anders, MD, chief medical officer, Medicomp Systems; Dan Gainer, CTO, Medicomp Systems. The presenters will provide an update on the health IT industry and a review of the company’s milestones and insights that it gained over the past two years. Topics will include Cures Act implications, interoperability, AI, ambient listening, telehealth-first primary care, chronic care management, and new Quippe functionality and roadmap.

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


Acquisitions, Funding, Business, and Stock

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Health IT company Emids acquires low-code enterprise software development and consulting firm Cloud Development Resources for an undisclosed sum.

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Reimagine Care, which supports at-home cancer care with remote patient monitoring and patient-reported outcomes, raises $25 million in a Series A funding round.

Change Healthcare is considering selling some of its assets to help gain approval for its sale to UnitedHealth Group, with payment integrity business ClaimsXten being shopped at a potential $1 billion sale.


Sales

  • Novant Health (NC) selects AI-powered triage and patient notification software from Aidoc.
  • MarinHealth Medical Center (CA) will outsource its administrative and RCM processes to Optum.

People

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Former North Carolina HHS Secretary Mandy Cohen, MD, MPH will join Aledade in March as EVP and CEO of its Care Solutions business.

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Jean Boyle (Sectra) joins Intelerad as VP of global professional services.

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Sue Schlichtig (NextGen Healthcare) joins Oracle as industry executive director of healthcare.


Announcements and Implementations

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Healthcare AI app vendor Treatment launches a probability-based symptom assessment tool that it says consumers find more like seeing a doctor than Googling symptoms online.

The University of Rochester Medical Center (NY) implements pharmacy analytics from Loopback Analytics.

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HSHS Good Shepherd Hospital (IL) goes live on Epic.


Government and Politics

ONC seeks public input on electronic prior authorization standards, implementation specifications, and certification criteria that could be adopted within its Health IT Certification Program. Comments are due March 25.


Other

UCSF pilots a payment program in which some providers are paid for responding to patient emails that take more than a few minutes to compose or require medical evaluation. Reimbursements from public and private payers have averaged $65 per consultation. Patients are advised when messaging providers through the patient portal if their correspondence will incur a fee. Medicare and Medicaid patients have typically not seen any extra cost, while privately-insured patients have seen co-pays between $5 and $10.

AMA and CAQH call for payers and providers to worth together to improve the accuracy of health plan provider directories, whose erroneous information frustrates patients, delays their care, and creates unexpected expenses from misstated insurance coverage.

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ThedaCare makes national headlines (of the undesirable type) for suing seven of its employees to prevent them from taking jobs with nearby Ascension-owned competitor St. Elizabeth Hospital. ThedaCare accused St. Elizabeth of endangering the community by “poaching” seven of its 11 stroke team members. The employees, who said they applied to posted St. Elizabeth jobs without being recruited, said that ThedaCare declined to make counteroffers to match St. Elizabeth’s higher compensation and more attractive working hours. ThedaCare’s lawsuit failed as the new St. Elizabeth’s employees started work there Tuesday, just one day later than planned. Ascension’s legal brief is full of entertaining sarcasm, leading off with, “Your failure to prepare is not my personal emergency” and noting that St. Elizabeth’s offers similar services seven miles away, “just without the fancy designation ThedaCare appears to view as a better use of funds than paying its workers.”


Sponsor Updates

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  • Availity employees help Big Brothers Big Sisters of Northeast Florida collect more than 400 toys for the organization’s holiday toy drive.
  • CareSignal publishes a case study titled “How OSF HealthCare Uses Deviceless Remote Patient Monitoring to Scale its Virtual Care Strategy.”
  • AGS Health publishes a new white paper, “Partnering for Transformation: SCP Health Reduces Costs by 28%.”
  • Arcadia publishes a new white paper, “What Drives Long-COVID? Understanding Complex Interactions with Real-World Data.”
  • Bamboo Health releases a new e-book series, “CMS’ E-Notifications CoP: The Route to Compliance – Part 4.”
  • CHIME releases a new Digital Health Leaders Podcast featuring Cerner Enviza Head of Global Strategy Jeremy Brody.
  • Change Healthcare releases a new podcast, “A New Approach to Alcohol Treatment.”
  • ChartSpan publishes a whitepaper, “Follow the Money: Medicare’s New Gold Mine is Chronic Care Management.”
  • Clearwater promotes Adam Nunn, Dawn Morgenstern, and George Jackson to directors of consulting services; Wes Morris to senior director of consulting services; and Mikaela Lewis to principal consultant.

Blog Posts


Contacts

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

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Morning Headlines 1/25/22

January 24, 2022 Headlines 2 Comments

DarioHealth Enters Agreement to Acquire Physimax, a Leading Provider of Validated Computer Vision for Musculoskeletal Health

DarioHealth, which specializes in digital chronic care management for providers, payers, and employers, acquires Israel-based digital MSK screening and risk assessment company Physimax.

Truentity Health Secures $1M in Pre-Seed Funding to Help Providers and Pharmacies Manage Medications Across Multiple Systems

Medication management startup Truentity Health has raised $1 million in pre-seed funding.

ONC Seeks Public Comment on Electronic Prior Authorization Standards, Implementation Specifications and Certification Criteria

ONC issues an RFI seeking public input on electronic prior authorization standards, implementation specifications, and certification criteria that could be adopted within its Health IT Certification Program.

Curbside Consult with Dr. Jayne 1/24/22

January 24, 2022 Dr. Jayne 4 Comments

Many healthcare organizations are struggling with the recent COVID surge due to the omicron variant. The focus is often on staffing issues, especially when large numbers of workers are out due to personal illness, caring for sick family members, or providing care for children whose schools have shifted to virtual learning. Other struggles include supply shortages, especially with personal protective equipment, medications and therapeutics, and occasionally cleaning products, all of which are shocking at this stage of the pandemic.

More recently, though, a number of organizations are seeing infrastructure challenges due to the sheer number of patient visits that are occurring.

I spent some time over the weekend trying to calm a CMIO friend whose ambulatory organization is in complete crisis. In the past, they had a robust IT department and hosted all of their own applications. In a round of cost cutting, the parent organization decided it would be better to outsource all of those functions. At the same time, they moved many of their internally hosted systems onto web-based platforms where available.

Their primary ambulatory EHR was one of those systems. It wasn’t just moved out of their data center — it was also transitioned to a SaaS model with multi-tenant architecture. This was fine for a number of months, but recently their system has been grinding to a halt at various times during the course of a day, and the user community is becoming increasingly frustrated.

Many of their outpatient clinical offices are back to pre-COVID productivity, through a combination of in-person and virtual visits. Because this organization is conservative, its conducts all of its telehealth visits by video, which take up more bandwidth than an audio-only visit. Their urgent care and same-day facilities have been seeing high volumes throughout the pandemic, but they have been fairly stable numbers for the last few months since operational leaders wisely capped daily volumes in order to preserve staff sanity.

I’m sure they have lost some patients to other facilities in town, but they consider the leakage acceptable if it keeps staff from resigning. They made these decisions based on experiences from earlier in the pandemic when they didn’t cap volumes, which led to some pretty significant burnout and nearly insurmountable levels of turnover. They weren’t about to put their newly rebuilt staff through the same experience, and for that I commend them.

Still, they were puzzled why they were having such poor system performance with stable volumes. As a hosted client, the IT team was opening performance tickets left and right, but with few answers. System latency continued to increase along with user frustration, as it was taking up to 30 seconds to load patient charts or 20 seconds to navigate from screen to screen. Even basic controls such as pick lists and pop-ups were also sluggish. Performance would improve at times and they would feel like they were moving in the right direction. The urgent care locations, which run seven days a week, reported some slight improvement on the weekends, but not much.

After many conversations with the vendor and a number of executive escalations, it became clear that the way the vendor’s system is architected is the problem. After moving from their own data center onto the SaaS model, the group is experiencing lags related to the out-of-control visit volumes other clients. They are feeling performance impacts that are caused by organizations who had doubled or tripled their daily visit volumes, putting additional load on the infrastructure. Since many of us didn’t anticipate how quickly the COVID curve would climb with the omicron variant, and how many people would be sickened in such a short interval, planning for such volume surges was inadequate.

Sometimes solving infrastructure problems can be as challenging as solving staffing problems in the hospital. Especially if the system is already running towards the higher end of capacity, there might not be available hardware that can be incorporated quickly. In the crisis situations that many 24×7 organizations are working in, it’s not easy to schedule a downtime for an upgrade or to modify resources. A lot of things can be done behind the scenes, but the reality is that most of us never planned for a peak that looks like what we are experiencing.

I can’t imagine what the staff at these doubly- or triply-busy practices are going through. They have got to be at wits’ end, because increasing throughput to that degree requires more staff, better processes, or less care being delivered. Based on what we know staffing looks like, and the difficulty in doing significant process changes during a crisis, I’m guessing care might be taking a hit. That would certainly mesh with the discussions I’m seeing on physician-only social media, where the number of mentions of moral injury has climbed along with the number of posts in which physicians are asking for advice on how to break their contracts.

My CMIO friend’s vendor was supposed to try to some maneuvers over the weekend that would create relative isolation for his organization so that they wouldn’t be so dramatically impacted by what is going on with other clients. I’m trying to wrap my head around what their architecture might look like to make that happen. It makes me grateful for all the deeply techy people I’ve worked with over the years who understand better than I how those pieces of the healthcare IT world run.

I wouldn’t want to be on the tip of the spear, whether it was my fault or my vendor’s, because an angry end user is an angry end user regardless of where the root cause of the problem lies. Regardless, I can offer a sympathetic ear, a soft virtual shoulder, and reassurance that his communication strategy was solid and that he had considered all of the things that I would have considered were I in the same unenviable position. He’s going to let me know mid-week how things are going, and for his sake, I hope they’ are improved.

Have you encountered infrastructure challenges related to booming visit volumes? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/24/22

January 23, 2022 Headlines No Comments

Francisco Partners to Acquire IBM’s Healthcare Data and Analytics Assets

IBM will sell its Watson Health business to private equity firm Francisco Partners at a price likely in the $1 billion range.

Emids Acquires Cloud Development Resources, Creating the Strategic Low-Code Development Partner for Healthcare and Life Sciences

Health IT company Emids acquires low-code, enterprise-focused software development and consulting firm Cloud Development Resources for an undisclosed sum.

Hearst Health forges partnership with the UCLA Center for SMART Health to offer the Hearst Health Prize in Data Sciences

The UCLA Center for Smart Health and Hearst Health will jointly offer the Hearst Health Prize, which will recognize data science initiatives that improve outcomes.

Monday Morning Update 1/24/22

January 23, 2022 News No Comments

Top News

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IBM announces that it will sell its Watson Health business to private equity firm Francisco Partners. Terms were not disclosed, but previous reports suggested a price in the $1 billion range.

The assets involved include Health Insights, MarketScan, Clinical Development, Social Program Management, Micromedex, and imaging software products. These came from $4 billion worth of acquired companies — Truven Health Analytics (data and analytics), Merge Healthcare (imaging), Phytel (population health management), and Explorys (real-world evidence from participating health system EHRs).

IBM says the sale will allow it to focus more on its platform-based hybrid cloud and AI strategy.

An analyst said last week that IBM is shedding assets that divert its attention, require capital investment, and present a risk to the company’s reputation, concluding that “Watson Health certainly qualifies for all three.”


Reader Comments

From Policia: “Re: IBM Watson Health. Not a great buy by Francisco Partners.” Damaged goods and an anxious seller can offer opportunity to a buyer, especially if their intention is a quick flip (which is always the hope of private equity firms). Thoughts from the cheap seats that we all occupy unless we were sitting in the deal meetings:

  • FP has obviously taken a deep look under the covers and has a track record of competence. That alone, plus IBM’s desperation to find a buyer over many months, suggests that FP got a fire sale deal.
  • We don’t know exactly what they are buying since the announcement just says “healthcare data and analytics assets from IBM that are currently part of the Watson Health business.”
  • Rumored numbers put the unprofitable business at $1 billion in annual revenue at a $1 billion sale price. Paying a 1x multiple builds in a lot of downside protection for the buyer.
  • Truven was the crown jewel, as IBM paid $2.6 billion for a company that was making maybe $400 million in annual revenue. But some of Truven’s juicier parts – life sciences data and government consulting – are rumored to have been previously integrated with other IBM offerings and won’t be conveyed to FP.
  • The downside of Truven is that it was owned by a private equity firm for nearly four years until IBM bought it, so investment and employee retention may have suffered in that 10 years to the detriment of future competitiveness.
  • The deal includes the MarketScan research databases, which offer real-world, de-identified life sciences data from claims and EHRs. That would seem to be a potentially high-demand business.
  • The former Merge Healthcare could probably be packaged up for sale pretty quickly to one of the international imaging companies.
  • IBM probably overpaid in spending $4 billion on the acquisitions, but that was in 2015 and early 2016 when health IT valuations were a lot lower.
  • IBM is keeping Watson itself, which likely means that its AI and natural language processing capabilities also stay with IBM. Therefore, the deal is a data play, especially since the AI part of Watson Health ended up accomplishing basically nothing except serving as the subject of marketing fiction.
  • The announcement says that “the current management team will continue in similar roles,” for which I’ll complete the sentence with, “until we can hire entrepreneurial leaders who would never have worked for a money-losing IBM business.”

HIStalk Announcements and Requests

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The biggest drop in social network use is Facebook, poll respondents say, with Twitter a distant second. Annoyingly posted Wordle scores may send more users fleeing as did Farmville and other mindless games before it.

New poll to your right or here: What are your HIMSS22 plans for in-person attendance? I’m thinking about running a “guess the attendance” contest, but I’m cautious since the big HIMSS21 numbers didn’t jibe with the ghost town I saw.


Webinars

February 9 (Wednesday) 1 ET. “2022 – Industry Predictions and Medicomp Roadmap.” Sponsor: Medicomp Systems. Presenters: David Lareau, CEO, Medicomp Systems; Jay Anders, MD, chief medical officer, Medicomp Systems; Dan Gainer, CTO, Medicomp Systems. The presenters will provide an update on the health IT industry and a review of the company’s milestones and insights that it gained over the past two years. Topics will include Cures Act implications, interoperability, AI, ambient listening, telehealth-first primary care, chronic care management, and new Quippe functionality and roadmap.

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


Sales

  • Behavioral healthcare provider WellStone chooses Owl’s behavioral health platform.

Announcements and Implementations

The UCLA Center for Smart Health and Hearst Health will jointly offer the Hearst Health Prize, which will recognize data science initiatives that improve outcomes. The award is changing from its previous focus on population health, as offered by by Thomas Jefferson University.

A Defacto Health analysis finds that two-thirds of payers have implemented provider directory APIs as required by CMS since July 1, 2021. The rule is intended to increase provider network transparency and to encourage third-party developers to create patient access tools for in-network provider search and health plan shopping.


Other

Employees of Ascension St. Vincent’s (FL) who were overpaid during the three pay periods of Kronos payroll system downtime complain that the hospital gave them one week’s notice that it will start garnishing 50% of each paycheck until the overpayment is returned. The hospital responded to a TV station’s inquiry by saying that it will offer flexibility to the overpaid employees, including allowing them to apply unused PTO hours to the money owed. I can say from experience that trying to get hospital employees to return money they never should have been paid is a near-impossible task that creates a lot of puzzling anger of the “I already spent it” variety.

Data protection magazine CPO runs an article whose title of “Big Tech’s Brazen HIPAA Violations Are Unethical, Immoral, and Legally Actionable” is 33% incorrect since HIPAA is binding only on covered entities and their business associates, not Facebook or Google. The author believes that his phone sent his Google Maps location to Google, which then served up healthcare-related ads. That would suggest that he had not disabled geolocation on his phone and browser. You have to accept HIPAA for what it is, not what you want it to be.

COVID-19 deaths Friday were at nearly 3,900, with the pandemic’s total hitting 864,000.

The local TV station’s “Problem Solvers” fails to solve the problem of a mother who was billed an $850 facility fee for a video visit. Children’s Hospital Colorado suggested that the TV station “speak to other providers, insurers, and legislators” to make insurance more widely available, but declined to justify or reduce the charge. The mother was especially annoyed that some of the physicians on the call were also sitting at home, equally far from the facility for which she was paying but nobody was using.


Sponsor Updates

  • Diameter Health recaps its 2021 accomplishments that include revenue growth, expansion of the executive leadership team, and launching a new brand of “Upcycling Data.”
  • The Business Intelligence Group honors OptimizeRx and its AI-driven Therapy Initiation and Persistence Platform with a 2022 Big Innovation Award.
  • Healthcare Triangle releases a shareholder update highlighting its 2021 achievements.
  • Nordic Consulting launches an EMEIA healthcare advisory team.

Blog Posts


Contacts

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Weekender 1/21/22

January 21, 2022 Weekender 1 Comment

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Weekly News Recap

  • Quest Diagnostics will acquire Pack Health.
  • Big funding is announced for Lyra Health, Gale Healthcare Solutions, Big Health, Wheel, and Verana Health.
  • Babylon acquires DayToDay Health.
  • ONC and The Sequoia Project publish TEFCA.
  • CliniSys acquires Horizon, combines with Sunquest to operate under the CliniSys name.
  • VA pushes its second Cerner go-live back due to staff shortages.
  • MPulse Mobile acquires HealthCrowd.
  • CHIME launches the degree-granting CHIME University.

Best Reader Comments

At its core, Blockchain is a database. It is the slowest database ever invented due to the need to write multiple entries for every read or write transaction. Therefore it has no place in a fast paced healthcare environment. Anyone who thinks otherwise needs to spend 10 minutes with a busy physician. (Was A Community Hospital CIO)

For almost 20 years, I’ve been promoting a key factor he acknowledges. Rephrased it is “involve the patient in the decision loop through both price transparency and quality scores” so they can re-engage in their total healthcare. Our third-party payer system has kept patients, if not in the dark, at least in the shadows, and an informed patient will make better decisions. (David Wellons)

For all those reasons, the data that is used to train AI is, challenged at best, and crap at worst. You can get through the note and see what you need to see as a human today, but training up AI from that variation is nowhere near being ready. The last 10 years are rife with AI failures, but we keep thinking that without changing the underlying data and data failure causalities, we will get a different result. (J Brody Brodock)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. K, who asked for Kids First Robot Engineering Kits for her STEM class in S. Ozone Park, NY. She reports, “These cute robot engineering kits are a big hit with the little ones! My kindergarten and first-grade students jumped right in with these robot kits. They seemed to know what to do immediately. There is a book that comes with the kit to show what to do, but they were so excited to build their robots themselves, without any help. Thank you so much for making this possible! I am so happy to have new and exciting materials for my students to use and to make coding and engineering so much fun!”

Oregon has 10% of its available hospital beds occupied by patients who are ready to be discharged, but have nowhere to go because long-term care facilities are too short-staffed to accept them.

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Minnesota signs a pandemic staffing deal that will pay a private company $275 and more per hour for temporary nurses, $345 per day for living expenses, and 1.5 times the hourly rate for overtime and double for holidays, courtesy of federal taxpayers who are footing the bill. Providing the help is Galveston-based construction company SLS, which has earned billions from post-hurricane cleanup, construction of President Trump’s border wall, and the opening of several expensive COVID-19 field hospitals that saw virtually no patients while their doctors sat around making $900 per hour.

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Penn radiologist Saurabh Jha, MD, self-proclaimed as the “first Indian Radiologist-General of the USA,” has good Twitter thoughts and a fun quote from this piece:

It’s tempting to conclude that we’ve lost all f**ing perspective. But lack of perspective isn’t the whole story. The reality is that we’re thoroughly bored – a side effect of affluence. This is why we have revolutions in our heads and fight wars on our devices. We storm the Bastille without moving from our couches. Instead of calling each other Nazis, we could just as well say “whatever,” press the mute button, and roll our eyes.


In Case You Missed It


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IBM Sells Watson Health

January 21, 2022 News 10 Comments

IBM announced this morning that it has signed a definitive agreement to sell its Watson Health business to technology-focused investment firm Francisco Partners. Terms were not disclosed, but previous reports said that IBM was seeking a price in the $1 billion range.

The assets involved include Health Insights, MarketScan, Clinical Development, Social Program Management, Micromedex, and imaging software products.

IBM says the sale, which it expects to close in the second quarter, will allow it to focus more on its platform-based hybrid cloud and AI strategy.

IBM launched Watson Health in early 2015 and made a series of acquisitions that cost $4 billion. They included Merge Healthcare, Truven Health Analytics, Phytel, and Explorys.

IBM’s then- CEO Ginni Rometty called the project a “moon shot,” but her replacement was less enthused about the business. An analyst said last week that IBM is getting rid of assets that divert attention, require capital investment, and present a risk to the company’s reputation, concluding that “Watson Health certainly qualifies for all three.”

Other active healthcare-related investments of Francisco Partners include Avalon, GoodRx, Kyruus, Orchard Software, QGenda, Trellis, and Zocdoc.

Morning Headlines 1/21/22

January 20, 2022 Headlines No Comments

Quest Diagnostics to Acquire Patient-Engagement Company Pack Health to Improve Value-Based Care

Quest Diagnostics will acquire virtual health coaching company Pack Health in an all-cash deal whose value was not disclosed.

Lyra Health Completes $235M Funding Round, led by Dragoneer, to Fuel International Expansion

Lyra Health, which offers online and in-person workforce mental health solutions, raises $235 million in financing.

Gale Healthcare Solutions Secures $60 Million Growth Equity Investment from FTV Capital to Remedy National Nursing Shortage

Gale Healthcare Solutions, whose platform helps hospitals contract and manage per diem and travel nurses, receives a $60 million growth equity investment.

Big Health raises USD75m in Series C round led by SoftBank Vision Fund 2

Big Health, which sells apps for insomnia and anxiety to employers and health plans, raises $75 million in a Series C funding round, increasing its total to $129 million.

News 1/21/22

January 20, 2022 News No Comments

Top News

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Wheel, which offers companies a platform and services to develop a virtual-first care offering, raises $150 million in a Series C funding round, increasing its total to $216 million.


Webinars

February 9 (Wednesday) 1 ET. “2022 – Industry Predictions and Medicomp Roadmap.” Sponsor: Medicomp Systems. Presenters: David Lareau, CEO, Medicomp Systems; Jay Anders, MD, chief medical officer, Medicomp Systems; Dan Gainer, CTO, Medicomp Systems. The presenters will provide an update on the health IT industry and a review of the company’s milestones and insights that it gained over the past two years. Topics will include Cures Act implications, interoperability, AI, ambient listening, telehealth-first primary care, chronic care management, and new Quippe functionality and roadmap.

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


Acquisitions, Funding, Business, and Stock

Quest Diagnostics will acquire virtual health coaching company Pack Health in an all-cash deal whose value was not disclosed. Quest will place the company in its HealthConnect extended care services offering, which offers insurance companies services for members such as in-home risk assessments, health screening, and social determinants of health review. HealthConnect was formed in 2018 via Quest’s acquisition of home-based risk assessment and monitoring vendor MedXM. Pack Health CEO Mazi Rasulnia, PhD, MPH, MBA founded the company in 2013.

Outpatient physical rehabilitation platform vendor WebPT acquires Clinicient, which offers an outpatient rehab therapy EHR/PM and a patient outcomes tracking and benchmarking service.

Lyra Health, which offers online and in-person workforce mental health solutions, raises $235 million in financing.

Gale Healthcare Solutions, whose platform helps hospitals contract and manage per diem and travel nurses, receives a $60 million growth equity investment.

Big Health, which sells apps for insomnia and anxiety to employers and health plans, raises $75 million in a Series C funding round, increasing its total to $129 million.

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Investor Mark Cuban launches an online pharmacy that offers low prices on 100 generic drugs to cash-paying consumers. Mark Cuban Cost Plus Drug Company buys drugs directly as a registered wholesaler, then sells prescriptions at actual cost plus 15% and a pharmacist fee. The company says it will not work with with third-party pharmacy benefits management companies that it says inflate drug prices. The online pharmacy is operated on Truepill’s digital health platform. The company lists a 30-day supply of thyroid drug levothyroxine at $4.20 versus the $16 list price, although I notice that Walmart sells it for $4.

Cerner SEC filings indicate that President and CEO David Feinberg and CTO Jerome Labat have waived their right to voluntarily leave the company within 12 months of the close of Oracle’s acquisition of Cerner. If Oracle terminates them, they will get $4.5 million and $2.3 million in cash, respectively, plus accelerated share vesting. Feinberg was hired in August 2021 and Labat in June 2020.

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Points from the twice-yearly health IT market review of Healthcare Growth Partners:

  • Revenue multiples in M&A and buyout transactions rose from 5.1x just before the pandemic started to 6.9x today, a 36% increase that still fell short of the Nasdaq’s 50% rise.
  • Health IT private equity investment increased from a steady $10-$15 billion per year to more than $30 billion.
  • M&A deal volume increased 50%, but has settled back to a 13% increase.
  • The early 2021 “deal frenzy” was driven by excess market liquidity, the looming capital gains tax hike, pandemic-driven IT needs, and the fear of missing out. The second-half cool-down was caused by pullback of stimulus funds and a tax hike that was below expected levels, reducing transaction urgency.
  • HGP speculates that the market’s high value may level off, but may have hit a “new normal” as capital keeps flowing in at high valuations.
  • The highest median multiples involved companies whose business was revenue cycle management, telemedicine, population health management, and analytics, and life sciences technology. 
  • Not all health IT companies command premium valuations. Multiples are justified by growth, profitability, and recurring revenue.
  • Health IT had a “painful downturn” in the second half of 2021, underperforming the market and ending the year down 16% versus 2020’s 62% increase, with 71% of health IT companies ending the year with a lower share price.
  • Three-fourths of companies that began initial trading in 2020 or 2021 are trading below their initial price, with new SPAC-merged companies down an average of 44%.

Sales

  • DCH Health System (AL) will implement Pelita’s patient access and Virtual Intake Management systems.
  • Hunt Regional Healthcare (TX) will implement Cerner Millennium via its CommunityWorks delivery model.

People

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Huntzinger Management Group promotes Stephanie Wallace to VP of sales operations.

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UCSF Health hires Suresh Gunasekaran, MBA (University of Iowa Hospitals and Clinics) as president and CEO. He spent much of his career as CIO at UT Southwestern Medical Center and worked for IBM/Healthlink.

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George Pappas (DrFirst) joins cybersecurity firm Intraprise Health as CEO.

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Patient engagement system vendor MobileSmith Health hires industry long-timer Chris Caramanico (Orthus Health) as CEO. He replaces Jerry Lepore, who will remain on the company’s board.

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Coding solution vendor Aidéo Technologies hires Jason Sroka, PhD (SmartSense by Digi) as chief data sciences officer and Brent Backhaus (Olive) as CTO.

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Cheston Newhall (Appriss Insights) joins Bamboo Health as chief of staff.

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Atul Dhir, DPhil, MBBS (New Century Health)  joins PatientsLikeMe as CEO.


Announcements and Implementations

Ellkay enhances its LKCOVID-19 COVID-19 testing platform for large employers to include an employer dashboard, employee self-scheduling, direct-to-employee results, reports for compliant testing, pooled testing, and employee self-service for registration.

A National Academy of Medicine discussion paper says that while the pandemic increased the adoption of telehealth, it also exposed deficiencies in healthcare’s data infrastructure, where questions about COVID vulnerability factors, infection spread, hospital capacity, PPE availability, and identification of effective treatments and outcomes remained unanswered despite widely available yet disconnected digital data. The authors note that decision-makers were flying blind early in the pandemic because COVID-19 codes were not yet available in EHRs, EHR encounters could not be correlated to ERP-monitored staffing and physical capacity, and public health systems ran on underpowered, siloed systems.They also note that temporarily easing regulations related to HIPAA enforcement and clinician licensing improved patient care quickly. They compare EHRs to libraries, where moving paper documents to microfiche added little value beyond reduced storage costs, but moving records to machine-readable digital form opened up new “business linkage between data and services” paradigms such as online search and retrieval. They advocate incentivizing data-sharing and interoperability and the use of real-world evidence.

A University of Chicago study finds that negative patient descriptors – such as “resistant,” “non-compliant,” and “defensive” – were used by providers to describe black patients 2.5 times more often than for white patients. The authors note that previous research has shown that patients who are described with stigmatizing terms are less like to have their pain management needs met.

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Omron’s VitalSight is recognized with “best of” honors at CES 2022. The physician-ordered remote patient monitoring solution is delivered to the patient’s home pre-configured to share blood pressure measurements without requiring a WiFi or cellular connection.


Government and Politics

Hundreds of VA anesthesiologists complain about its intention to allow nurse anesthetists to practice without their supervision. That plan is related to a VA proposal to implement national standards that would take precedence over individual state laws, with those standards being implemented in its Cerner rollout.


Other

Researchers find little proof in the medical literature that mental health apps are effective. They conclude that some mobile-powered interventions might be better than nothing, which given their potential scale, might still be good news. Weaknesses of their study are that it was performed by meta analysis (reviewing existing literature, some of which includes poor study design and author bias) and it grouped apps together in broad categories. 

In Lisbon, Portugal, Uber Eats adds the capability to order a $23 physician telehealth session or a $91 house call.

Healthcare IT Leaders awards its employee recruitment prize to Kendy Valburn, a contact tracer and team lead for the company’s Healthy Returns return-to-work COVID-19 program. He provided a heartfelt, emotional response to the news that he will receive a new Tesla.


Sponsor Updates

  • HCI Group Chief Digital Officer Ed Marx joins QliqSoft’s advisory board.
  • Redox and PatientBond partner to offer personalized healthcare content within any EHR.
  • Meditech EVP Helen Waters will participate on panels during Google’s Healthcare 360 event on January 26 and MicroStrategy’s World 2022 event on February 1.
  • Healthcare Triangle releases a shareholder update.
  • The Wyoming Department of Health uses technology and services from NTT Data to overhaul its Medicaid program.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 1/20/22

January 20, 2022 Dr. Jayne No Comments

I’m getting ready for HIMSS in earnest, beginning to schedule meetings and the much-anticipated booth crawls with some of my BFFs. It’s always good to have a support team to help you spot eye-catching products, interesting giveaways, and of course the finest footwear.

Several people have asked me what I think will happen with exhibitors and whether people will drop out. At this point, I think I have as good a chance of predicting that as my old-school Magic 8-Ball. In looking at the vendor-side organizations I’ve had involvement with over the last couple of years, the breakdown is 10% not attending, 25% going stealth (will not have a booth but will attend the show and have private meetings), 15% exhibiting but might cancel or send a smaller team, and 50% forging ahead business as usual.

One of the things I’m most looking forward to is seeing people in person who I haven’t seen since HIMSS19. Although I attended virtually in 2020, that experience paled in comparison to the past. Friends humored me with lots of after-hours pictures and shenanigans, but I’ll be glad to be part of the adventure again.

Of course, that assumes that we don’t have another variant of concern pop up between now and then. It’s hard to believe we had no idea that omicron was going to be such a nightmare a couple of months ago. Here’s to hoping that given all the people who have been infected, the immunity it provides will be at least somewhat durable. It’s likely we won’t know that for quite some time, but I’m still hopeful. If it turns out that all the death and suffering and healthcare workers’ exhaustion of the last few months were for nothing, that’s going to make it all the more terrible.

I’m part of an online group that discusses alternative careers for physicians who want to leave traditional medicine. Sometimes the suggestions are decidedly non-medical, such as getting one’s real estate license or flipping houses. They may also include non-clinical careers that still require physician expertise, such as pharma, life sciences, or medical device manufacturers. Sometimes they even include staying in your specialty, but moving from a traditional practice to a locum tenens format to have more flexibility and variety.

This week, the discussion veered off into the realm of clinical informatics. I almost spit cocoa on my keyboard when one author said they were interested in clinical informatics because they wanted to get away from working with people.

I was happy to see several clinical informaticists chime in on how we work with people all the time. One noted that not only do we work with people, but often they are often tired and overworked clinicians just like the original poster. Another described the not-so-fun state of being caught between administrators who want to bloat the EHR’s configuration for business reasons and end users who want a streamlined experience that makes it easier for them to care for patients. It was clear that many of the people asking about it don’t understand the requirements needed to work at the top level in our field, such as fellowship training, board certification, or considerable experience.

I was proud of how the clinical informaticists represented our specialty – recommending an online typing tutor for the one-finger typist, AMIA 10×10 courses for the budding informaticists, and more. They encouraged the physicians interested in learning more to volunteer for technology committees at their organizations, take additional training for EHR workflows, or even pursue becoming a super-user if they are really interested in crossing to our side of the clinical trenches. We get to do and see a lot of cool things and it’s a different way of using our clinical skills to help large numbers of patients rather than just influencing those we could see in our own practices.

I was less proud of the non-informatics physicians on another thread that piled on for some complaints about EHR vendors. One chap talked all about his experiences with a particular system and how terrible it was and listed specific defects that made it unusable in his opinion. As someone who has used that system extensively, I became suspicious. Only by reading well below the scroll did you get to the part where he says that he hasn’t used the system in more than a decade. I’ve seen a lot of good EHRs and some bad ones too, but the biggest struggles I’ve seen are with decent EHRs that were ineffectively configured and implemented. I’m working with a vendor now that has extensive training resources and I wonder how many users know what’s available at their fingertips.

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I wasn’t surprised that the COVIDtests.gov website had a soft go-live on Tuesday ahead of its scheduled debut. It seems to be working relatively well except for some issues processing requests from multi-family buildings. The tests are limited to four per household and won’t ship for a while, which limits their utility during the current omicron surge. Testing capacity has somewhat improved in our community, but at-home test kits are still hard to find, leading to challenges for those hoping for a quick turnaround. A good friend knew I had a stash of kits and asked to use one, which was a fair trade given his history as a maker of excellent gin and tonics. After 15 minutes in my outdoor driveway COVID clinic, he headed home with at least a small measure of reassurance.

I didn’t think much about it because I was just glad to help a friend out, until he sent me a thought-provoking text: “You know what just struck me about last night? In the richest country in the world, I, a fully insured patient, had to turn to what amounts to a black market supplier for a medical test.” Funny but not funny, and painfully true. Maybe next time I have to offer some driveway swabbing, I’ll pair my gloves with a trench coat and some kicky boots.

What’s your most challenging experience trying to obtain a COVID test? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/20/22

January 19, 2022 Headlines No Comments

Wheel Raises $150 Million Series C to Power the Virtual-First Care Revolution

White-label telemedicine and staffing company Wheel raises $150 million in a Series C investment round that brings its total funding to $216 million.

Babylon Acquires DayToDay Health to Help Patients Recover at Home and Drive Down Rehospitalization

Digital health company Babylon acquires DayToDayHealth, a startup launched out of MIT that offers patients pre- and post-visit care education, communication, and clinical support via personal care teams.

VA seeks dashboard to coordinate $21B health record project

The VA seeks dashboard technology that can facilitate communications; convey scheduling, tasks, and deadlines; and support decision-making amongst stakeholders involved with its EHR modernization project.

HIStalk Interviews Russ Thomas, CEO, Availity

January 19, 2022 Interviews 2 Comments

Russ Thomas, JD is CEO of Availity of Jacksonville, FL.

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Tell me about yourself and the company.

Availity is the largest network in all of healthcare, connecting 2 million providers and every health plan in the country and transacting 13 billion healthcare transactions a year. We have a broad scope and broad scale in driving a lot of cool impact in the transformation of healthcare. I’ve been the CEO since 2012 and have loved every minute of it.

To what degree do you see EDI, networks, and clearinghouses still being innovative and vital for digital transformation?

My buddy Sean Wieland, the analyst at Piper Sandler, told me a few years back that he would love to see how we make clearinghouses sexy again. I kind of laughed, saying, “I’m not sure clearinghouses were ever sexy, Sean, but I’ll do my best.” You have to be transformational and innovative. Otherwise, it’s a commoditized business where you are selling essentially transactions at fractions of a penny. If you don’t innovate and evolve, then you become irrelevant pretty quickly. That’s where we’ve been super successful. We have always focused on real time. The company was started as a real-time network.

When you say EDI, I think batch and days in transaction processing and transfer versus milliseconds. That’s a real opportunity for businesses like ours, to take what today is a large network of very important transactional activity and evolve it into a network of interactions between providers and health plans and make sure that, on a real-time basis, you’re serving up content. We’re in the information business. We have to be able to serve up content to the right provider, right time, right patient in ways that can meaningfully improve that patient experience. I think that 21st century clearinghouses and networks like ours have to be able to do that and demonstrate that value in order to thrive.

Your most recent investment was from Novo Holdings, which has life sciences connections. Do you see an opportunity to expand into real-world clinical research data?

That’s not where we’re headed, to be candid with you. We are in such a trusted place with our customers — our health plans, providers and ultimately the members and patients that they serve — that I don’t think we need to go there. Just being a data broker isn’t particularly exciting to me. What’s exciting to me is this evolution of transactional relationship between providers and health plans to an interaction, meaningfully moving to digital engagement, digital platform between providers and health plans.

Today we live in this pretty siloed transaction environment where you run an eligibility check and you get a response to that. It may tell you to do something else. You run an authorization, you get a response to that. Then down the road, you submit a claim, you get a response to that. That’s not how healthcare gets practiced. Physicians are practicing in real time, and they are making real-time clinical decisions about how best to treat their patients.

The administrative networks haven’t kept up with, or at least haven’t advanced, to support that type of real-world relationship between providers and patients. That’s where we are focused, moving to this intelligent network that discerns information from the very first encounter between a provider and a health plan around the patient and helps that provider think forward to what they need to know during the patient visit and when they are making the referral. We need to follow the trajectory of the patient visit more than some sort of made-up transactional flow that has persisted for decades and doesn’t support the workflow in the provider’s office.

Where do you see the line between provider and payer blurring and what are the transactional needs that are involved?

There’s this opacity in healthcare between providers and payers, between providers and their patients, and between payers and their members that just has to get fixed. Payers clearly have to continue to demonstrate value in that, for lack of a better term, the clinical decision process. But that ultimately is a provider’s responsibility as the professional who makes the decision about what’s best for the patient. Where I think we can help, and I don’t have the ultimate answer, is to be able to move that decision-making process to something that feels more like a real-time, intelligent workflow. That would be a great start.

We know from our providers and even our payers that authorizations are the bane of their existence. No matter how big of a smile you put on it, it’s still just seen as a brute force utilization management tool. But payers have information about a member that might not be readily available to a provider, and when that is served up in the context of a real-time workflow process — whether that’s an authorization or referral or whatever it may be – it can drive a ton of value in that overall patient experience. That’s where we are focused.

One of the things I’ve always said about Availity is that we’re not an arms dealer. We are not provider centric. We are not payer centric. We are solution centric, and f we can create more transparency in those complex workflows where both the provider and the payer are bringing value to the table, then there’s a lot of upside for us and a lot of growth potential. 

We can start to knock down some of these walls between providers and payers around who is bringing value and at what point in the cycle. Providers would say that, by and large, payers don’t bring a lot of value in a clinical review process. The payers would say they need to keep a close eye on these providers because in the absence of utilization management processes, you get a significant overutilization and abuse of the healthcare system. I don’t know that I believe that either one of those is true. Value can be delivered on both sides of the equation.

To what extent are providers using clinical information that they can get only from a payer?

Our model is that we sell products and solutions to payers and we sell products and solutions to providers. We sit in a unique place where we are able to grow our business through our relationship with both sides of the equation. The answer to your question is that is growing. We are seeing more utilization of clinical data going both ways. We are seeing more clinical data being served up to our provider network from our payers to help close gaps in care, particularly in the Medicare Advantage space to get to the right utilization for HEDIS and other scoring purposes. We are seeing more and more data flow to the providers and then come back.

We’ve done a lot of integrations into provider systems to be able to pull out clinical data, attachments, charts, other things that are then consumed within a payer’s system to try to help come to a better and faster solution to an authorization workflow, for example. We are doing real-time, automated authorization workflows where we are reaching into the provider system, extracting clinical data in the provider context, translating that to payer-speak, and using that to help automate the authorization workflow within the payer systems. That is a big area of growth in the market and for us.

What challenges remain with building a network and integrating with EHRs?

You have to look at the endpoints on the network, which in healthcare are its users. We have solved a lot of the core administrative network issues, getting to the right person within the billing office, the front office, or other places where historically the adoption of technology has been pretty high. But we are still not nearly 100% penetrated into the parts of the provider organization where clinical decision-making is being done. We’re not penetrated into the clinical coordinators, the nurse practitioners, and the folks that all day, every day are trying to help manage these more complex clinical workflows with unstructured data and that sort of thing.

As a company, we have 2 million connected providers into our network, but we haven’t gone deep and created connectivity to the right users in all of those offices and all those facilities. There’s a real focus on expanding the use of Availity within a provider organization to make sure that we are bringing value not just to the scheduling person, billing person, or front desk intake, but also to those clinically oriented professionals within the organization.To a large degree, we have only scratched the surface of the value proposition there.

I think you build that all from a single network. There’s no reason to have a clinical network, an administrative network, and a financial network. When you do that, you create silos that then create more opacity in the process. But there’s work to be done to get to that nirvana state of a true holistic network.

What is driving investor interest in companies that offer patient payments technology?

We’re pretty small in that space right now. We help a physician collect a deductible upfront, but it’s not a big piece of our business. The interest comes from the right place. What we’ve done over decades is fairly completely disconnected the consumer from the provider. It’s the only section of the economy where we’ve done it quite so thoroughly.You and I as consumers of healthcare are still mostly ignorant to what a service costs, what the options are, and what is being billed versus what is being collected. We’ll do $2.5 trillion of billed claims through our network this year, of which 50 or 60% actually gets reimbursed. Where did the other trillion dollars go? You and I as consumers certainly don’t know where it went.

The desire to move into the patient billing and patient reimbursement space comes from the right place of saying that to drive the demand-side healthcare economy, you’ve got to connect the consumer with the provider of a service and the cost of that service. Strategically, I think that’s where these companies are trying to go. I’m not sure that anyone has completely figured out the timeline the process to get there. But it comes from the right place, even if it’s just to create awareness with a consumer that even though my responsibility for the services is only $50 or $100, I want to know what it really cost and what the options are, because there may be an option where I don’t have any deductible or there may be a higher quality option. Today, it’s just so difficult for us to get any visibility into those choices.

What will the company’s focus be in the next few years?

We’ve built a great culture here as a company. By and large, people really like working here. We have a revitalized leadership team with some great new leaders who joined us over over the last year. One of the things we’ve learned is that COVID has changed the way we work, changed our business, and changed the way we run the business. I’ve been in healthcare tech for over two decades and the energy around change and faster evolutionary processes is higher than I’ve ever seen it. It has to be.

The move to digital should be user experience driven, not technology driven. This move to a digital platform and a digital experience for our users is going to be our top area of focus. Moving to this interaction-based workflow within both our products and the way that we serve up data to our B2B customers is a great place for us to be as a company and a place where we can both grow and bring a lot of healthcare system. As we sit here today, we transact, by our estimates, half or so of all the healthcare transactions in the country. We sit in a pretty interesting place to be impactful if we try. We are going to give it a hell of a try.

Morning Headlines 1/19/22

January 18, 2022 Headlines No Comments

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