HIStalk Interviews Don Woodlock, VP of Healthcare, InterSystems

Don Woodlock is VP of healthcare at InterSystems of Cambridge, MA.

Tell me about yourself and the company.

I have been in healthcare IT my whole career. I went to school next door to where I am now, at MIT. I joined the company IDX and worked there for 14 years building applications, basically billing, scheduling, and managed care. I joined GE Healthcare for 14 years doing imaging IT –radiology, cardiology, and labor and delivery type imaging. I’ve been at InterSystems for four years.

InterSystems focuses on two areas. One is a data platform. We have software companies, maybe most famously Epic, that build their applications on our technology. Then we have an interoperability product line called HealthShare that many of your readers would use. We have an EMR that we sell outside the US called TrakCare.

Northeastern companies such as InterSystems, Meditech, and IDX had a lot of influence on today’s health IT market going back into the 1960s and 1970s. What does that impact look like from the inside?

There’s a technology similarity, but the most important similarity — at least in the original IDX – is the private company, customer-obsessed model. Epic still has that, InterSystems still has that, and IDX had that while I was there. It was a small group of individuals who were really excited about health systems and were focused on that. They didn’t want to bring their companies public. 

That model and culture is familiar to me. I had a 14-year deviation when I went to GE Healthcare, but when I joined InterSystems, it completely reminded me of IDX, that same kind of friendly, customer-focused outlook. Maybe there’s a Boston-y culture to the whole thing. It’s a nice place to be.

Technologists from outside of healthcare may know little about Caché. Can you explain its benefits?

That market has come around a little bit more. This multi-model, key-value store wasn’t popular at all in the early days when the technology got started, and was not popular during the relational days. But in the last five to 10 years, there has been more variety in the way people see databases and different models. Caché’s power comes from this key-value model, which makes it scalable and efficient. You can build an application that scales and micromanage the way your data is actually stored. That’s part of Caché’s secret sauce.

How are the company’s integration and interoperability solutions used?

Our integration engine is used by 39 of the top 100 hospitals and health systems. Your readers may know it under the name Ensemble, but we market it now as HealthShare Health Connect. It translates from HL7 to FHIR to X12, from whatever format to another format. It scales really well and is the next generation of that category.

The broader HealthShare is a data aggregation, unified care record platform. It got started in the state HIE market a long time ago. We more often use it for health systems that want to aggregate data across all their different EMR systems. We also market it to payers, life sciences companies, and regional health authorities outside the US. It focuses on unifying patient data and making it useful for point-of-care, analytics, research, and many other use cases.

With interoperability, we are in the middle of a nice, big change from HL7 — which is more of a “copy data from here and put it there” model, that copy-and-paste model — to FHIR, where you have applications that can work together and can request information from each other. It’s a much better interoperability model and it also opens up a lot of innovation, where you can treat your EMR data as a FHIR repository and build applications on top of that more easily. We are at the beginning of a next era in interoperability that will be quite fruitful and useful to our industry.

What market exists for helping life sciences companies use provider EHR data for research, real-world evidence, and product monitoring?

We’ve had a lot of increased activity with life sciences companies. There’s the research side, which is running successful trials. Using real-world data helps you with study planning. I’m looking for diabetics over 50 on this medication — how many people can I find in my population that is used for site selection? What organizations should I approach to run my trials? Then there’s the patient recruitment process, having real-time interoperability of information so that my principal investigators at the different sites can identify patients as soon as they enter the system.

This market has been aided by more healthcare information being digitized. It has also aided by regulatory agencies that are more open to real-world data being part of a research submission.

Then there’s the commercial side. You have a drug or a therapy and you want to get it out to the market, so you need to understand that market. A broader array of data helps you understand where your patients live, what other medications they are on, and what other problems they have. Having this data enables a life sciences company to more effectively operate these days, and I think that most of pharma is recognizing that now.

How has product demand and the company’s strategy changed with healthcare’s move to the cloud?

The cloud enables innovation. On-premise is like our waterfall software development process, while cloud is more like agile, lean, and a minimally viable product. It enables you, as a health system that wants to innovate, to spin up a FHIR repository, spin up a development stack, and try a proof of concept. To build a small application and not necessarily have to have pre-thought all of that and to buy a lot of hardware. You can focus on that stable environment.

You can more easily innovate and adapt in a cloud-based environment. That’s in addition to operating a data center better and more effectively with a cloud partner. The interesting part of the cloud is the innovation and the ease of starting up and taking advantage of newer technologies.

Our predominant model of healthcare applications, like HealthShare, is to offer it as a service. Customers may choose on-prem, but generally speaking, most of our new projects are us managing the entire environment for a customer. Then we are starting to introduce cloud-based services. Earlier this week, along with Amazon’s launch of HealthLake, we launched our HealthShare Message Transformation Service, which allows HealthLake to speak HL7. You can see it in the AWS marketplace. You can spin it up today and start using it.

We anticipate that more and more of our offerings will look just like that. We’ll offer it in the cloud stores. Customers can spin it up and start using it. The amount of friction needed to get started with InterSystems technology will be lower.

Healthcare users may not be aware that InterSystems has customers in other industries.

InterSystems is a multi-vertical company. We have a lot of experience in healthcare, but we are building up a more robust financial services business. The majority of trades that happen in the US stock exchanges go through InterSystems technology. We have another interesting customer who is basically the NASA of Europe. The European Space Agency tracks all the bodies in the sky using InterSystems technology. We have a lot of neat customers in other verticals as well.

TrakCare is a fully functional EHR that is in the top three in the world. We sell in 28 countries. The root of that business was a customer of ours named TrakHealth in Australia that had built an application on our technology. We became closer and closer with TrakHealth and eventually acquired them and made them part of InterSystems. We have a big business in the UK, Italy, Australia, New Zealand, China, the Middle East, and Chile. We enjoy having a global EMR product, but having a level of what we call local editions that tailor it for these specific markets.

Would you ever develop or acquire domestic healthcare applications, or do you have agreements with customers such as Epic to avoid competing with them?

We don’t have an agreement, but we feel like the EMR market in the US is pretty well saturated and pretty well taken care of, including by our good partner Epic. We don’t have any plans to launch TrakCare in the US. I don’t think it would add a lot to the market, honestly.

It must be unusual for a company that is approaching $1 billion in annual revenue to be owned outright by a single person, Terry Ragon in the case of InterSystems. What are the advantages of that form of ownership and how does it influence the company’s long-term plans?

There’s nothing like the private company model when the company is profitable and doing well. I enjoyed my time in GE Healthcare, but you have this other stakeholder, which is the shareholder and quarterly earnings concerns. That’s another kind of stakeholder that you need to worry about, please, and perform for in addition to customers, which is this other sphere. That was the only sphere I ever cared about, honestly. It’s nice to be in a private company with the one owner. It’s a simple model, where I can focus on customers all day long and not really worry about the rest.

We don’t have any concerns about the long run. We haven’t made it a priority to figure out the long-run transitions. We’re happy now. My boss, the CEO and owner, comes in every day. I just met with him earlier. We have a fully staffed senior leadership team, a 1,600-person-strong company, and a great customer base. We are enjoying ourselves pleasing customers.

How will the company’s healthcare strategy change in the next few years?

We are migrating more and more to analytics. That is natural in our industry. We’ve collected all this data, we’ve digitized our workflows within health systems and providers, and now we want to get more out of that. A lot of our customers are migrating to using their data for analytics. The types of things we do around interoperability, data aggregation, and normalization are all useful for the analytics use case. We have been focusing on a lot of projects and offerings in that respect.

Even our underlying data platform historically has been that online transactional processing system, and more and more customers want to build analytics solutions on it. We’re adding a number of features around self-service analytics, Python, integration, and embedded machine learning, a number of things that are more analytics-oriented to our product line. That is a big part of the future.

The other would be what we talked about concerning cloud. Having more and more of our offerings be click-click services that you get in, start up, and start to use instead of larger decisions that involve a larger monolithic type of implementation.

Do you have any final thoughts?

It’s not InterSystems related, but I wanted to thank you for publishing HIStalk. I’ve been in health IT for 33 years and I have been a dedicated reader of your publication since it started. Healthcare IT is such a community, and while my former colleagues and I from other companies run into each other all the time, it is nice to read about folks and see what is happening across the industry. HIStalk is one of the most important things that bind us all together. It has been a joy to read, and I look forward to it every day.

Morning Headlines 7/21/21

WebMD Acquires The Wellness Network, Expanding Point-of-Care Services to Health Systems and Hospitals

WebMD acquires The Wellness Network, which offers advertising-supported patient education videos and broadcast channels for hospitals.

Massachusetts eHealth Collaborative Fulfills Mission; Completes Final Dissolution

The Massachusetts EHealth Collaborative dissolves and distributes its assets to six public charities, saying that it has completed its work and fulfilled its mission related to interoperability, standards development, and health IT policy.

Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments

An EHR trigger analysis of the VA’s corporate data warehouse finds that nearly one-third of patients who were admitted for stroke had been discharged from the ED with seemingly benign headache or dizziness in the previous 30 days.

News 7/21/21

Top News

WebMD acquires The Wellness Network, which offers advertising-supported patient education videos and broadcast channels for hospitals.

Reader Comments

From A Concerned Citizen: “Re: HIMSS21. Will it be cancelled, or just set records for poor attendance? Between the delta variant and the White House report that ranks Las Vegas the most dangerous of all metropolitan areas, registration must be falling quickly.” A couple of readers said their employers have instituted policies that will prohibit their planned attendance. I was about to say that it’s too close to the conference kickoff to contemplate shutting down the live component, but then I recalled that HIMSS20 was cancelled March 5, four days before it would have started. A virtual-only conference is the backup plan, but I don’t think that HIMSS could survive losing its main money-maker for two consecutive years. I predict the show will go on, even with an attenuated audience.

From Tom Paine: “Re: IBM Watson. Former CEO Ginny Rometty is to blame for overhyping it. It was presented as the great hope for IBM, while more important initiatives like the cloud fell further behind.” Rometty should have been skeptical about the Watson hype given that her degree was in computer science and electrical engineering and her IBM background was mostly spent in technical roles. IBM is usually late to parties at which competitors have already taken the best seats, so maybe the draw of being an early entrant into AI was appealing. The company’s biggest Watson mistake was probably choosing healthcare as its showcase, a hill that many swaggering tech companies have died whimpering on. 

HIStalk Announcements and Requests

I found the Clear Health Pass app frustrating to use for HIMSS21 vaccination verification, especially since my submission is stuck in “pending verification” status. I strongly recommend using Safe Expo Vaccine’s online option instead, as recommended by reader Susan Newbold. The submission page is 1990s clunky, but it took seconds to submit photos of my driver license and vaccination card and then just another 1-2 minutes to have it confirmed by email.

More evidence of the decline of US journalism – it seems that every news website now features cursory “product reviews” that hope to entice readers to click to buy, generating an affiliate commission for the site. The link is almost always to Amazon because it pays those commissions reliably and people are more likely to buy from Amazon anyway, meaning that non-Amazon products are ignored along with other sites that offer the same item cheaper.

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

The Massachusetts EHealth Collaborative dissolves and distributes its assets to six public charities. The organization says it has completed its work and fulfilled its mission related to interoperability, standards development, and health IT policy.

Sales

• Georgia-based ACO TC2 will implement Jvion’s Avoidable Admissions technology.
• St. Bernard’s Hospital (AR) selects NICUtrition clinical decision support software from Astarte Medical.
• North Mississippi Health Services will implement Picis Total Perioperative Automation software with Envision Analytics from Picis Clinical Solutions.

People

Adam Laskey (Cerner) joins EverCommerce as GM of EverHealth.

VitalTech names Chad Haynes (Cerner) as chief commercial officer.

John McCullough (Cleveland Clinic) joins The Chartis Group as principal in its Informatics & Technology practice.

Patricia Daiker, RN (Dragonfly Lights) joins Orb Health as VP of clinical operations.

Signify Health names Sam Pettijohn (Cerner) chief growth officer and Erin Kelly (CVS Health) chief commercial officer.

Industry long-timer Scott Weingarten, MD, MPH (Cedars-Sinai) joins Medicare Advantage insurer SCAN Group as its first chief innovation officer, where he will launch its geriatric primary care medical group.

Shayna Schulz (Blue Shield of California) joins Grand Rounds Health and Doctor on Demand as COO.

Announcements and Implementations

Illinois Bone & Joint Institute begins implementing Epic at its facilities in Illinois and Indiana.

McLaren Health Care implements Medi+Sign’s automated patient communication technology across its network in Michigan and Ohio.

Covenant Health rolls out tele-ICU services at its facilities in Tennessee using technology from Hicuity Health.

InterSystems develops HealthShare Message Transformation Service, enabling users to convert existing data formats to FHIR standards to populate Amazon HealthLake.

Amazon’s AWS machine learning blog profiles Medhost’s migration of all its data to AWS to provide patient access and to support advanced analytics and compliance needs. 

Wolters Kluwer announces EmmiEducate, which delivers patient educational material.

Other

JAMA-published research finds that medical debt is the largest source of debt in collections in the US, now totaling $140 billion from the 18% of Americans who hold medical debt that has gone to collection. Total medical debt is likely larger since hospitals are increasingly suing patients rather than selling their debt to collections agencies at a discount. The total also does not include balances owed on credit cards or payment plans. Medical debt is increasing faster in the 12 states that do not participate in the ACA’s Medicaid expansion program (AL, FL, GA, KS, MS, NC, SC, SD, TN, TX, WI, WY).

And EHR trigger analysis of the VA’s corporate data warehouse finds that nearly one-third of patients who were admitted for stroke had been discharged from the ED with seemingly benign headache or dizziness in the previous 30 days. The authors approached the study not to prove the existence or extent of diagnostic errors, but rather to (a) highlight the need to validate the data that appears to prove such problems for such issues as miscoding; and (b) use it as a springboard for reviewing ED workflow and clinician diagnostic methods to reduce future harm from missed diagnoses.

Sponsor Updates

• InterSystems and University Hospital Sharjah celebrate a decade of successful partnerships for digital transformation.
• Infor and Change Healthcare announce their support for the AWS for Health initiative.
• Kyruus describes the use of its ProviderMatch platform by AtlantiCare (NJ).
• Diameter Health has been selected by AWS as a Connector Partner for Amazon HealthLake.
• CereCore welcomes Michael Gagnon (NTT Data) as its first Enterprise Fellow.
• Diameter Health publishes a case study featuring HealtheConnections, “Improving Ambulatory Clinical Quality Measurement Using a Consolidated Patient View.”
• The Lifelong Customer Podcast features Dimensional Insight VP of Marketing Kathy Sucich.
• Elsevier Clinical Solutions releases a new Clinical Insights Podcast, “How Well are COVID-19 Vaccines Working in the Real World?”
• Experian Health announces that its Enterprise Health Patient Identifier Solution and Hospital Claims Management Systems have been deemed top-rated solutions in Black Book’s 2021 “Top Client-Rated Financial Solutions Achieving Accelerated Digital Transformation in the Nation’s Healthcare Systems.”
• EClinicalWorks releases a new podcast, “How Population Health Solutions Improve Patient Outcomes and Experiences.”

Blog Posts

• How a family medicine practice protected revenue and served more patients with telehealth (Ability Network)
• What are the economics of remote patient monitoring for your practice? (AdvancedMD)
• Acquire and Secure Medical Images with Mobile Devices (Agfa HealthCare)
• Disaster Preparedness: How Ready Are We for Hurricane Season? (Audacious Inquiry)
• Understanding First Call Resolution and what it means for your healthcare system’s bottom line (Bluetree)
• Pre- and Post-Pandemic: Comparing SNF Quality Ratings (CarePort)
• Advancing health equity: Understanding and meeting the challenges with data (Cerner)
• Reining in Costs by Closing Care Gaps: Next Steps for Payers (Collective Medical)
• Reimagining Healthcare Technology at NCPDP 2021 (CoverMyMeds)
• Insights from the Inside: CHIME Members Discuss the Future of Managed Services (Cumberland Consulting Group)
• Winning the Medical Information Game (EClinicalWorks)

Contacts

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

Morning Headlines 7/20/21

Quit Genius Raises $64M to Expand Access To #1 Digital Clinic for Substance Addictions

Quit Genius, a virtual care company specializing in treatment for substance addiction, raises $64 million in a Series B funding round.

Verisys Acquires Credentials Verification Organization Services From Advantum Health

Verisys, which recently announced its merger with Aperture Health, acquires Advantum Health’s Med Advantage Credentials Verification Organization business.

DuPage Medical Group outage resolved, but ‘minimal delays’ may remain

DuPage Medical Group, the largest independent groups in Illinois, recovers from a nearly week-long network outage that impacted several systems.

HIStalk Interviews Tom Skelton, CEO, Surescripts

Tom Skelton is CEO of Surescripts of Arlington, VA.

Tell me about yourself and the company.

I’ve been in healthcare IT for a long time now. Believe it or not, it has been 40 years. The focus of my career has been digitizing healthcare, predominantly from the perspective of providers. Over time, it moved into different segments.

Surescripts has been around for 20 years now. It was stood up to solve some of the nation’s most significant problems. That was e-prescribing at the time, but we’ve expanded and broadened since then. We have never wavered from our purpose, which is to serve the nation with the single most trusted and capable health information network. Our focus remains patient safety, lower costs, and higher quality care.

How did use of the Surescripts network change with the pandemic?

Our focus has always been on either the prescribing process or informing care decisions and providing information to the caregivers, usually at the point of care. We saw a number of things occurring during COVID. There was a huge change in the telehealth landscape. Lots of new entities were springing up, and even within established entities, large health systems were innovating in the world of telehealth. We saw a much greater use of the network.

The other thing that happened was there was a greater focus on public health type information and the need to inform federal, state, and local agencies what was going on in the world of COVID. Folks repurposed some of our solutions to do that. For example, our clinical direct messaging offering was never intended to do that type of reporting, but that’s what people did with it. 

We think that that’s an example of how innovation is going to occur in the world of interoperability. We are all accustomed to certain use cases. We think that the consumers of those use cases are going to make those things valuable in ways that maybe we didn’t anticipate or intend.

What has the company learned in not just allowing healthcare participants to exchange information, but making the external information actionable?

It used to be that establishing a connection was a huge issue. It still takes a lot to do that and get it right, but that’s getting easier and easier. As it does, there’s a greater focus on the quality of the information that is being moved and how it appears in a natural workflow for the consumer of that information. Surescripts and our network alliance are focused on enhancing the quality of that information.

It’s making sure that the standards that exist — and there are many of them – are being implemented in a way that everybody agrees on how to utilize them and how to populate the individual fields or to populate the data elements. So that when it hits the workflow of a physician, pharmacist, or any clinician, it is appearing in a way that they can consume it and use it to enhance the care that that patient is being given. We see a lot of time and energy being put in to that.

Direct messaging seemed like it was going nowhere for a long time. How have you seen the Direct concept as well as your specific Direct platform progressing?

It’s interesting that you make that observation. That solution has been around for a while. It’s one of the few general solutions that exist in the world of interoperability. You are right that when it first came out, because it wasn’t use case space specific, people weren’t sure what to do with it. Over time, they are finding solutions here and finding that it can be an effective way to share information, provided that the sender and the recipient are on the same page in terms of what’s being said. We certainly saw that during COVID.

We are seeing a lot of work with that as we are working with health plans and helping them to do outreach to the physician community. These are the types of solutions that we are bringing to bear to help inform those care decisions that the prescribers, providers, and clinicians are making.

How do you see the information exchange market between providers and life sciences companies evolving?

Those companies have a a significant role to play here. They are major players in what goes on with the patient. They are obviously very interested from their own standpoint about what’s happening with the brands that they are putting out there. They want to know how their products are being used and what the adherence rates are. They want to make sure they are communicating with the prescribers. In many cases, they want to have access to the patient.

They have a great interest in the whole world of interoperability. We see that and understand that need. That’s one of the challenges we will face as interoperability grows. Life sciences wants access. Health plans want access. PBMs want access. One of the challenges for clinicians will be to make sure they are getting the right information without being overwhelmed with information.

How do healthcare networks add value?

An individual network can add value in many places. A lot of networks in healthcare are doing great work, whether it’s in the clinical world like we are, or whether it’s in the administrative world like some of the other folks.

Moving that information and helping to connect the ecosystem is a pretty daunting task. We have two million healthcare professionals. We are sharing actionable intelligence for 320-plus million patients. We are processing over 17.5 billion transactions a year. The role of the network continues to be not only facilitate that connectivity, but to ensure the reliance, the resiliency, the quality, basically the trust between the sender and the recipient and making sure that people that are requesting information are who they say they are and are entitled to that information and really do represent the patient that they’re requesting the information about.

There’s a lot that goes on there to maintain trust across the ecosystem. All of that contributes to how networks add value.

What influence will the Trusted Exchange Framework and Common Agreement have?

There’s a variety of mechanisms that the regulatory bodies are putting out there to help facilitate interoperability, whether it’s increased focus on standards, something like TEFCA, or whether it’s the information blocking legislation that was put through and is out there. All of that has value and helps to move it forward. It’s incumbent upon all of us in healthcare that are moving this information to tell our stories effectively as well.

One of the great challenges in the market is that each of us has an anecdote that we can tell that indicates that interoperability is not perfect. But we’re all moving a lot more information than we ever have, and it’s on us to share that information so that everybody understands how far along in the journey of interoperability we are and how far we’ve come. There’s still a long way to go, but a lot of good progress has been made.

The creation of those networks also creates business value. We’ve seen high levels of health IT investment activity and company valuations, but Surescripts has been quiet in terms of acquisitions or market transactions. Why is that?

We were founded to stand up one of the earliest networks in the market, particularly as it relates to clinical. Our goal here is a bit different than the goals of some of these other folks. We’re not chasing EBITDA. We’re not chasing an exit. That’s not what it’s about.

What it’s about for us is establishing, operating, and innovating on an existing platform that is neutral in the ecosystem, that is designed to facilitate the movement of that clinical information. Our growth has been driven by organic investment and continues to be driven by organic investment. We think that that’s a fabulous way to go. We think it also gives us the ability to take the long view and to make investments that other organizations may not be willing to make, and we think there are advantages there.

Where do you see the company in the next three to five years?

We are looking at what’s going on in the market and seeing many of the same things as everybody else. We’re seeing an increase in chronic conditions. We’re seeing the impact of high-cost specialty drugs. We’re seeing doctors facing ever-increasing rates of burnout. There’s a lot going on around us.

Our focus will be, number one, to sure that we optimize the prescribing process. We’ve got a lot of work to do in the area of specialty. We need to stay focused on that. We need to remove friction. We need to do things that advance and improve adherence and make it easier for all Americans to get the medications that they need.

The second thing for us comes back to that getting information to the provider community at the point that they need it. Solving that need for informing care decisions by giving them the actionable intelligence that they need and continuing broad-based connectivity for clinicians all across the market.

We remain purpose-driven. That’s who we are and we are very comfortable in that world. Our goal is to continue transforming these interactions among clinicians, pharmacists, and patients.

Do you have any final thoughts?

We’ve seen a lot of investments in the market. We’ve seen a huge influx of capital. We think that shows the amount of opportunity that there is here.

We think there’s a tremendous amount of room for innovation. We are excited about that. We see a continued acceleration of the trends that enabled virtual care. We think there’s going to be a lot of innovation to come that will help further information sharing across the healthcare ecosystem. The pandemic accelerated that and we look forward to continuing that over the next three to five years.

Curbside Consult with Dr. Jayne 7/19/21

Due to changes in licensure waivers as states decide that the pandemic is over, despite the fact that we’re not even close, my telemedicine work is becoming rather spotty. Unlike some of my colleagues, I don’t have a dozen state licenses, so I’m limited on the patients I can see.

For part-time people like myself who the telehealth vendors hire as independent contractors, it’s difficult to justify the effort to obtain multiple state licenses, not to mention the ongoing costs. Licensure in the US is a patchwork across the states. Although some belong to an interstate compact, others don’t, which makes it even more confusing.

Looking at my nearby colleagues, however, nearly everyone is practicing some flavor of telemedicine, whether it’s some evening moonlighting or as part of expanded offerings on behalf of their practice. I’m always interested to hear about telemedicine experiences from my proceduralist colleagues, so I enjoyed reading this article in JAMA Surgery last week. It specifically addresses the use of telemedicine in surgical subspecialties, proposing that telemedicine will go beyond being a “pandemic adaptation” and will continue to evolve. The article outlines the timeline of increasing telehealth surgical services – initially when elective surgical procedures were suspended and surgeons began to use the technology for preoperative, follow-up, and emergent surgical care visits, but then later in 2020 as COVID-19 cases began to spike.

The authors note that current telehealth technology can make it difficult for surgeons to physically assess their patients and may impede interpersonal communication. However, many patients are able to report specific data points, such as vital signs and pain scale that are often gathered during a visit, and patients are certainly able to tell a physician whether it hurts when they move or touch certain parts of their body as well as what their current level of activity might be.

They cite several potential advantages for telehealth surgical services, including improved access, continuity of care, and reduced disparities. Additionally, patients may have less travel time and expense. Although the authors don’t specifically mention it, I know from personal experience that surgical telehealth consultations have opened up availability for second opinions across the US. One of my close friends was able to have consultations with multiple renowned surgical oncologists in a matter of days, which might have been weeks to months had she needed to travel. Of course, that doesn’t take into account the time she would have missed from work or the travel expenses.

The article goes on to focus on three factors that will most impact the degree to which telemedicine will replace and/or supplement in-person visits.

First, they note that “with interpersonal relationships being a core attribute of high-quality surgical care, perhaps more targeted implementation of telemedicine is required.” They propose established patients as “an attractive subset” for postoperative visits or routine follow up. My only major surgery was somewhat emergent, and I certainly didn’t have the opportunity to form an interpersonal relationship with the surgeon, who came to the hospital early on a Sunday morning to remove a gallbladder that had gone rogue. The next morning, I was seen by a nurse practitioner from the office, handed a script for 10 Percocet, and hustled out the door. A post-op incision check took less than 90 seconds, and I honestly can’t remember if there was even an exam or if it was just a visual inspection of the surgical sites. The idea that our physician-patient relationship was a core attribute of anything kind of makes me laugh.

Second, they note that “substantial technological innovation is still needed to enhance surgical diagnostic capacity of telemedicine.” They propose the use of remote monitoring and wearables to provide supplemental biometric data such as heart rate, sleep time, activity levels, and electrocardiogram data. They note a need to process the data “in clinically meaningful and easily presentable ways” to “accelerate their use in clinical practice.” I don’t disagree with that. None of us want to see hundreds of disparate data points that might be out of context. However, this bullet might relate better to some surgical subspecialties than others.

Third, and I think most of us agree with this, “given the direct relationship between insurance coverage and adoption of health care innovation, continued coverage for telemedicine services and further refinement to the existing policies are needed to sustain this mode of health care delivery.” They go on to mention that payers are already rolling back coverage for telehealth services not related to COVID-19, and if it hasn’t happened by the time this piece comes out, it’s likely that Medicare will soon end coverage for audio-only telehealth visits. This is going to be the end of telehealth services for many patients, especially those who struggle with technology or who might not have the capability of executing a video visit.

A few messages down my inbox was another article about telehealth. Specifically, “how to bring warmth to your virtual care visits.” This piece from the American Medical Association seeks to answer the question: As the US health care system remakes itself into one that includes more virtual visits, how can physicians maintain the empathy and “human touch” that are so crucial to a strong patient-physician relationship?” It summarizes comments from the AMA’s Telehealth Immersion Program, which is designed to help physicians implement, improve, and build their telehealth efforts.

The speakers quoted in the piece have some good points, such as seeing things in the context of a video visit that they wouldn’t have seen in-person – such as fall hazards in the home, companion animals, etc. However, they note the need to focus additional effort on communication skills and relationship management. Most of the tips offered though are the same we’d recommend for physicians struggling with in-person communication – communicating clearly, showing respect, taking time, and displaying empathy. I didn’t find anything new or earthshaking in the article, but then again, I rarely do when the AMA is the source.

One thing that I think health systems and other entities need to think about when they’re talking about expanding telehealth is balancing the convenience factor with the need to support physicians. For example, if an in-person visit typically has a support staff member who documents the chief complaint, assesses and documents vital signs, reconciles medications, and updates histories, then there’s no good reason to simply shift that work back onto physicians. Unfortunately, that’s what we see in a lot of telehealth practices. Some of it is because organizations are still using telehealth solutions that are not fit for purpose or integrated with the EHR, and other times it’s because organizations are just taking advantage of their clinicians.

Those organizations that offer more transactional or direct-to-consumer telehealth services need to be careful about expanding those offerings without thinking about their providers. Many telehealth-only physicians moved into that sector because they prefer the transactional nature of that model of care. Simply put, they don’t want to go back to doing the things they hated in practice, such as tracking gaps in care, refilling medications, reviewing pages of blood pressure logs, and more. If they’re asked to take on additional responsibilities, they’re likely to ask for greater compensation, which will be interesting in an industry with a fairly thin margin.

All in all, it’s clear that telehealth is here to stay. I’m sure it’s going to continue to evolve, although I don’t have a crystal ball to know which way things might go next.

What do you think about the evolution of telehealth in the US? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/19/21

What Ever Happened to IBM’s Watson?

The New York Times says that IBM Watson failed to achieve its goals to transform industries and make IBM successful, noting that Watson’s healthcare “moon shot” failed in multiple health systems.

Real-World Data & Technology Company OM1 Closes $85 Million Financing To Make Healthcare More Measured, Precise, And Pre-Emptive

OM1, which offers chronic disease registries and real-world data, raises $85 million in financing.

Intermountain Healthcare Provides Notice of Data Security Event

Intermountain Healthcare (UT) announces that PHI from four of its clinics may have been compromised during an April cyberattack on care management software vendor Elekta’s systems.

Monday Morning Update 7/19/21

Top News

The New York Times says that IBM Watson failed to achieve its goals to transform industries and make IBM successful. It says that Watson’s capabilities were oversold by IBM’s top executives – mostly former sales and services people – who ignored the warnings of the company’s scientists that it was a one-trick pony that was built purely to win “Jeopardy.”

The article notes that Watson’s healthcare “moon shot” failed in multiple health systems, as the technology was not capable of performing real-time cancer diagnosis or smart literature searches. IBM has discontinued its genomics and oncology offerings after they failed in high-profile health systems.

IBM’s Watson Health business spent $4 billion to acquire Merge Healthcare, Phytel, Explorys, and Truven Health Analytics. The company is reportedly considering selling those businesses as it lags competitors in cloud computing. Watson Health is reportedly bringing in $1 billion in annual revenue but still loses money.

NYT says Watson is “a sobering example of the pitfalls of technological hype and hubris around AI,” but says the technology has improved to the point that it can manage workhorse natural language tasks as offered by IBM’s cloud competitors, such as task automation and virtual assistants.

Reader Comments

From He’s Not Here: “Re: remote patient monitoring. Doesn’t that term contain a bit of geographic paternalism?” It does. Healthcare was historically built around the “my patients come to where I am” model, where other than for the rare house call, the provider has always sat in their building and waited for people in need to show up. I would say that in itself is not paternalistic since it’s no different than any other retail or professional business that doesn’t involve services that are provided in the home or on the road, but the idea that a patient is “remote” begs the question, remote from what? It’s the same as “after hours” care – after whose hours? Still, while some monitoring could be performed regardless of patient location, the capability must exist to react to it by dispatching humans, and that’s a last-mile problem for many patients, especially when health systems and the emergency services providers who have boots on the ground are almost always disconnected and sometimes competitive.

HIStalk Announcements and Requests

Most poll respondents presume that information blocking exists when Epic-using providers in the same area aren’t sharing patient data. My opinion is that we know that most EHRs can exchange patient data – as evidenced by at least one client of each vendor who is actually doing it – so ONC should focus on eliminating the “we weren’t aware” provider excuse via outreach and setting patient expectations to increase interoperability demand.

New poll to your right or here: Which tech company will have the most impact on US healthcare in five years? I will leave it up to respondents to define “healthcare impact.”

Dear companies – while I appreciate the option to engage with your website chatbot even though I can’t imagine a situation in which I would actually do so, please do not make it beep at me, especially every time I navigate to a new page of your site. That’s not exactly a testament to your software usability expertise.

We’re doing some pre-HIMSS summer slacking off around here lately. Jenn was vacating last week so we posted few sponsor updates, while I was day-tripping with Mrs. HIStalk Friday and elected to skip writing the Weekender. It feels good to have places to go and things to do after losing last summer to hunkering down, but sometimes having so many options available again makes me anxious that I’ll miss something.

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

OM1, which offers chronic disease registries and real-world data, raises $85 million in financing.

Sales

• Baystate Health (MA) expands its Cerner implementation with HealtheIntent for its physician organization and unspecified revenue cycle solutions.  

People

Gary Christoph, PhD died earlier this month of Parkinson’s Disease at 76. He spent time as CIO of HCFA (now CMS), leading it through Y2K and cybersecurity and writing many of the regulations contained in HIPAA. He also led IT for NIH and Northrop Grumman’s healthcare IT group.

Government and Politics

The Senate confirms Donald Remy, JD as VA deputy secretary, its second-highest official. He will take charge of the VA’s Cerner project. Remy, who was confirmed in a 91-8 vote, is an Army veteran and COO / chief legal officer of NCAA.

A patient advocacy group’s review of the websites of 500 hospitals finds that 471 have not posted their prices as required by federal transparency rules that took effect January 1. The group says the $300 per day penalty should be increased.

Other

A JAMA Network Open article suggests that physicians avoid the use of “stigmatizing language” in their notes since patients may see them. The authors suggest avoiding language that questions patient credibility, indicates disapproval, stereotypes race or social class, indicates that the patient is difficult, or that conveys a paternalistic tone.

Three weeks before HIMSS21, the COVID-19 resurgence in Las Vegas causes the Venetian, Palazzo, and Sands to once again require their employees to wear masks, regardless of vaccination status. The health district is also recommending that everyone wear masks while indoors, advice that will surely be ignored by 99.5% of visitors. The Nevada Gaming Control Board has not re-imposed casino masking policies so far. The HIMSS21 “no masks required” policy remains aligned with CDC and county recommendations since all attendees must be vaccinated. COVID-19 case counts, positivity rates, and hospitalizations in Southern Nevada have returned to February levels, with 78% of those new cases being accounted for by Clark County. More than half of the state’s residents have not been fully vaccinated. The situation is so significant that the public health chief of Los Angeles has advised locals, especially those who are unvaccinated, to avoid travel to Las Vegas.

Sponsor Updates

Blog Posts

• A Revenue Cycle Guide for Private Equity Firms in Healthcare (RCx Rules)
• 10 Key Facts Hospitals Should Know About Denials in 2021 (Vyne Medical)

Contacts

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

Morning Headlines 7/16/21

VA Electronic Health Records: Modernization and the Path Ahead

The VA pauses its Cerner rollout after an internal report finds significant problems, with VA Secretary Denis McDonough telling the Senate Veterans’ Affairs Committee that he will make changes in project oversight, training, implementation sequencing, and budgeting.

Waystar to Acquire Patientco to Bring True Consumerism to Healthcare, Simplifying Payment Processes for Patients and Providers

Waystar says the combined companies will offer a consumer-friendly patient payment experience.

Introducing AWS for Health – Accelerating innovation from benchtop to bedside

AWS will offer a set of services and partner solutions for healthcare, genomics, and biopharma.

OSF OnCall: A New Hospital Without Walls

OSF HealthCare opens its OSF OnCall Digital Health building in Peoria, IL, from which it offers remote patient monitoring, nurse triage, and ICU patient monitoring.

News 7/16/21

Top News

VA Secretary Denis McDonough tells the Senate Veterans’ Affairs Committee that he is putting the VA’s Cerner implementation on hold. This follows completion of a three-month project review that found serious “governance and management challenges.”

McDonough says that the VA’s first implementation at Mann-Grandstaff VA Medical Center (WA) in October 2020 did not live up to its promise of “seamless excellence in VA care,” adding that the report found “numerous patient safety concerns and system errors” as well as significant negative impact on productivity.

McDonough said he commissioned the review after hearing firsthand about duplicated prescriptions at Mann-Grandstaff and a user’s complaint that a Cerner help desk employee was unable to answer a user’s questions because he had just one week’s experience. He added that clinicians tell him that most of the integration between the respective Cerner systems of the VA and DoD happens inside their heads, not on their computers.

McDonough vowed to improve training and testing, to increase its oversight of Cerner, and to make leadership changes to get the project back on track. He also says the original plan to roll out Cerner by geographic area was a mistake and scheduling of go-lives will now be based on evidence of readiness.

The cost of the project, which was originally estimated at $10 billion when Cerner was awarded a no-bid contract in 2017, has risen to over $20 billion. McDonough has ordered a new budget estimate for the entire project, which will include the several billion dollars of infrastructure upgrades that the original estimate missed.

Committee chair Senator Jon Tester (D-MT) told the group, “I’ve had the impression for some time there are folks out there milking the cow. Every day they go out and they see this cash cow, and they’re getting every dime they can get out of it. There’s been damn little accountability. I hope Cerner’s watching this. Cerner’s not up to making a user-friendly electronic medical record, and in fact what’s transpired here is we’re going in the opposite direction, then they ought to admit it and give us the money back so we can start over.”

McDonough identified specific project issues:

• The VA lacks a specific definition of a patient safety issue and how to manage open issues.
• The decrease in productivity includes problems in revenue cycle, where much of the claims and payments process requires manual entry.
• Cost estimates did not include any issues beyond the Cerner contract, infrastructure readiness, and the project management offices.
• The VA did not create key performance indicators.
• The patient portal experience was fragmented, leading the VA to study the user experience to support “decisions on the future of the portal” that takes legal and contractual obligations into account.
• Testing did not reflect real-world workflow.

Also offering testimony to the committee was Ellkay Chief Innovation Officer Marc Probst, MBA, who described the rollout of Cerner at Intermountain Healthcare when he was CIO and the keys to a successful EHR implementation. He responded to a question about what Congress should expect by urging clear goals, reductions in support tickets and complaints over time, and performance against real milestones. Asked if anything stood out for immediate action, Probst recommendation resetting expectations against original and current requirements and reviewing detailed project work plan milestones.

Reader Comments

From Rashaverak: “Re: Woman’s Hospital, Baton Rouge. This is the first I’ve heard that the sheer cost of an EHR implementation is driving a hospital’s business strategy, essentially forcing it into an affiliation or merger because it can’t afford its EHR of choice. It must be a record for Epic if the hospital’s stated cost is indeed $200 million over seven years – has Epic no shame for pricing the system at 10% of the 168-bed hospital’s total expense? That kind of pricing will keep Meditech and Allscripts around and makes the $1.2 billion that Partners spent over 10 years look like a bargain. Isn’t the goal of IT to bend the cost downward instead of upward?”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor VitalTech. The Plano, TX-based company offers more than telehealth. More than RPM. More than population health. VitalTech is the nation’s first fully integrated virtual care platform. The company develops technologies, platforms, and hardware that empower patients to better care for their health and wellness while enabling clinicians and health systems to remotely monitor, manage, and care for patients. Its integrated digital health platform, VitalCare, aggregates and contextualizes critical data that is collected from multiple devices, EHRs, and third-party sources. Data is then pushed via the VitalCare cloud to user apps, family connection apps, care teams apps, administrative web portals, and third-party integrations in real time so actionable insights can be made. The solution enables health systems, physicians, payers, employers, senior living facilities, skilled nursing facilities, and home health providers to streamline workflows while improving health outcomes, increasing patient safety, and lowering the cost of care. The suite includes easy-to-use devices and software that increase patient engagement and compliance. Thanks to VitalTech for supporting HIStalk.

VitalTech sent over a link to this intro video and client testimonial. Holy Name Medical Center CEO Michael Maron movingly describes how contracting COVID-19 and then infecting his own family was a “burden I’ll have to bear for the rest of my life,” but he says that being monitored by VitalTech’s system at least allowed them to recover at home.

Listening: old Genesis, which I didn’t follow until pandemic times. “Firth of Fifth” and “Supper’s Ready” are as good as music gets to my ear, and while I can’t abide the treacly 1980s hits of Phil Collins, he spent the late 1970s effortlessly backing and then leading a band of individual musical geniuses by drumming the most complex time signatures imaginable. Genesis wrote and played their best music, which I predict will be as timeless as Beethoven, in their late teens and early 20s.

I’m jealous of people starting new jobs who post photos on LinkedIn of the cool company swag that was waiting at their desk on their first office day. I don’t think I ever got anything when I took a new health system job.

It’s about time to post my HIMSS21 guide describing what HIStalk sponsors will be doing there, so submit your information this week. I’ve received submissions from 19 companies, including two who aren’t actually sponsors and thus will be regretfully unrepresented.

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

Healthcare payments software vendor Waystar will acquire Patientco, whose technology includes patient payments, communications, and engagement.

Bloomberg reports that the private equity owner of healthcare payments analytics vendor Cotiviti is considering an IPO that would value the company at $15 billion.

Sales

• MedStar Health chooses oncology data and analytics vendor COTA to support cancer research and care.
• An unnamed drug company will use OptimizeRx’s platform to offer physicians choices when their Medicare patients risk treatment lapse due to loss of coverage.
• Blessing Hospital (IL) selects CarePort Interop to allow it to meet CMS event notification requirements.

People

Frank Nydam, MBA (VMware) joins Tausight as chief development officer.

Glytec hires Scott Bettner, MS (Hillrom) as regional VP. 

Announcements and Implementations

Non-invasive digital sensor developer Rockley Photonics announces plans for trials of “clinic on the wrist,” a combination of hardware, firmware, and cloud analytics that measures biomarkers such as body temperature, blood pressure, hydration levels, and measures of blood alcohol, lactate and glucose. The company hopes to complete testing and release the product for commercial use next year. The company is about to go public via a SPAC merger.

Amazon announces AWS for Health, a set of services and partner solutions for healthcare, genomics, and biopharma.

Applied behavior analysis EHR vendor CentralReach acquires Behavior Analysts, Inc., which offers an ABA assessment system.

Amazon Web Services selects Diameter Health as a Connecter Partner for Amazon HealthLake.

OSF HealthCare opens its OSF OnCall Digital Health building at its headquarters in Peoria, IL. Capabilities of the “virtual hospital” include remote patient monitoring, fall prevent innovations, virtual nurse triaging, ICU monitoring, and monitoring 40 telehealth carts.

A KLAS report on cardiology systems says that no individual offering stands out, as organizations have pieced together multiple systems but are re-evaluating as part of their enterprising imaging strategy. Most often considered are Philips, IBM Watson Health, and Fujifilm, while Epic is often chosen as part of its product suite even though it lacks a cardiology archive and offers weak structured reporting.

Government and Politics

ONC hopes to have the Trusted Exchange Framework and Common Agreement (TEFCA) network open for participation in the first quarter of 2022.

The companies contracted by ONC to develop draft EHR Reporting Program developer measures seek feedback by September 14, 2021.

Other

In Ireland, people complain that their names are misspelled on their government-issued COVID-19 digital travel certificates and worry that the mismatch will prevent them from boarding flights, which the government says is due to hospital, doctor, and pharmacy systems that can’t handle language-specific punctuation and characters such as the fada.

Sponsor Updates

Blog Posts

• Step Back To Move Forward on Interoperability (Cumberland)
• 5 Signs you Need a Managed Services Partner (Optimum Healthcare IT)

Contacts

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

EPtalk by Dr. Jayne 7/15/21

So many health systems placed everything on hold during the pandemic, so I was excited to hear about a health system not only taking something live but building it themselves. Holy Name Medical Center’s emergency department went live on its homegrown EHR, powered by Medicomp’s Quippe solution. I’ve had the opportunity to test drive the Quippe Clinical Data Engine multiple times in recent years and it really is an impressive solution, so I can’t wait to see how Holy Name implemented it. It will be on display at HIMSS21 in the Medicomp booth and I’m looking forward to kicking the tires. Kudos to this team for the implementation even in the face of a pandemic.

Telehealth is here to stay, and I enjoyed reading a Medscape piece on “What should I wear to see my doctor?” Telehealth has changed the paradigm for care delivery at the same time that life in general has become more casual. I still balk at the idea that my telehealth employer wants us to wear white coats, since there’s no purpose to it other than having it shout, “hey, I’m a doctor.” The article shares a couple of anecdotes about multitasking patients, one who tried to do a medical visit while multitasking on a work Zoom meeting and another where the patient was cooking a meal during the visit. Those are certainly extreme examples, but there are many more where virtual visits have clued us into situations in the patient’s environment that we wouldn’t have known if they presented for in-person care.

There are also some pretty amazing stories about physicians being too casual for patient care, including one telehealth physician who lacked a shirt during a consultation. Another provider was written up by his network for drinking beer and eating chicken wings (both visible to the patient) during a behavioral health therapy session. I’m guessing he wasn’t trying to document real-time, because the grease load on anyone’s computer keyboard wouldn’t be desirable.

I personally use my telehealth patient care days as excuses to dress up, to bring out those chunky necklaces that I normally wouldn’t wear in person for fear of toddlers grabbing onto them or the dangly earrings that typically remained in the drawer for the same reason. I still don’t wear sassy shoes, though, mostly because I’ve become entirely too accustomed to living in the Kino sandals that have been my constant companion since the first time I visited Key West. That will all change in a couple of weeks, though, as I get ready for HIMSS.

HIMSS released the details of its COVID-19 vaccine verification process. All attendees, exhibitors, and staff will have to provide proof of vaccination through one of three processes: Clear Health Pass Validation, Safe Expo Vaccine Concierge Validation, or Safe Expo On-Site Validation. I decided to try the Clear Health Pass option and the experience was less than stellar. Once I clicked on the HIMSS-provided link in my email, I had to enter my phone number so I could receive a link via SMS to download an app. After waiting 10 minutes for it to install, I restarted the process, which started over in the download phase despite having been in the installation cycle previously. After another 40 MB of downloading, there was another three minutes of installation, after which I was asked to enter a code that I didn’t have. I guessed at HIMSS and HIMSS21 and the latter was successful.

From there, I went through multiple terms of use screens and consents, which I know the vast majority of users don’t or won’t read. From there I had to scan both sides of my driver’s license and then take a picture of myself, which rivals my passport for hideousness due to the app’s smile detection feature which forces you to basically frown. From there, I had to go through another selfie process, which converted my picture to a line drawing and seemed tricky to try to fit my face into its weird oval frame.

The next step was adding my vaccination information, for which I had to go through another consent then an electronic authorization to release data to Clear. From there I was instructed to log into MyChart and went through another disclaimer, followed by four panels of information regarding consent and release. Finally, I was asked to give permission to the HumanAPI app to release every scrap of data in MyChart, including allergies, the name of my physicians, demographics, documents, health goals, implants, lab results, medications, problems, orders, procedures, immunizations, vitals, appointments, clinical notes, encounters, referrals, smoking status, and OB/GYN status. It asked to allow sharing for the next 90 days.

I denied permission and went back to the option to submit a photograph of my vaccine card and to key in the vaccine information and dates. After less than 30 seconds, I received my validation, and I didn’t have to share a boatload of PHI to do it. The overall process took 26 minutes, which was way too long, and I imaginethat  if I had actually read all the consents and disclaimers, it would have been close to an hour. I’m sure everyone involved (except the patient/consumer) is making at least a little money on the sale of the personal data that thousands of people will release without thinking too much about it. Just say no to the API, folks.

Amazon Care has asked major health payers to cover its services on par with other in-network care options. Reported targets include Aetna, Premera Blue Cross, and Blue Cross Blue Shield of Massachusetts. Amazon Care was originally piloted with Amazon’s Seattle-area employees, but the company has tried to expand the product since March of this year, not only nationwide to Amazon staff, but also to other employers. Based on the challenges with getting coverage for telehealth, let alone some of the asynchronous services the platform purports to offer, it will be interested to see how long it takes for the big payers to bring the service into the fold let alone provide payment parity.

A recent article in JAMA Network Open looks at the ability of wearables such as Fitbit and Apple Watch to identify the long-term effects of COVID-19 infections. The data is from the Digital Engagement and Tracking for Early Control and Treatment trial (DETECT) which was led by researchers at the Scripps Research Translational Institute. More than 37,000 people enrolled in the study, which ran from March 2020 to January 2021. Subjects used the MyDataHelps research app to report symptoms and COVID-19 test results and shared data from their devices. Researchers concluded that when they looked at wearable data and symptom data together, they could detect COVID-19 cases more accurately than looking at symptom data alone.

A follow-up trial looked at Fitbit users with fever, cough, body aches, and COVID-19 test data. It found pronounced changes in COVID-19 positive patients compared to others. Symptoms included increased sleep, decreased walking, and higher resting heart rates. On average, the COVID-19 positive patients took 79 days for their resting heart rates to normalize compared to four days in the non-COVID-19 group. Definitely food for thought for all those who are still refusing vaccination and especially for those who think that COVID-19 is a hoax.

COVID-19 is on the rise in my area in a big way, and my former colleagues are being slammed. My former partner had 38 people on the wait list at urgent care this morning. Of those patients, 15 were COVID-19 positive. The most tragic story of the day was a family who came in for testing after seeing pictures of their COVID-positive cousin in the ICU on social media after they were all together for a July 4 event. The cousin didn’t even call family to notify them, just posted on social media. It sounds like they were beside themselves and I’m sure the positive results didn’t help things.

Speaking of social media, I’ve written before about some of the lesser talked-about aspects of social media, such as its role in the grieving process and how strange it feels for “memories” to pop up that might not be happy ones. I definitely had some strong emotions at the memory that popped up for me today, which was a picture of my mask-damaged face during a lengthy shift in the emergency department. It was a stark reminder of all that we’ve been through in the past year.

It also gave me pause because we’re still not learning the lessons we need to learn to deal as effectively with this pandemic as we need to. Many of us who read the medical literature and have close relationships with researchers understand that we’re literally one “variant of concern” away from being back at square one with this virus. There’s a constant sense of waiting for the other shoe to drop, and for some of us, I’m not sure we’ll ever be able to feel the sense of relief that we had in a pre-COVID world.

A close friend of mine is a counselor and executive coach who works predominantly with physicians. He agrees that there are thousands of us who meet the diagnosis criteria for post-traumatic stress disorder but who have not addressed it with employers or sought treatment, and in reviewing the criteria during our discussion I’m betting a lot of clinicians don’t know they have it. I’m curious to know if employers are doing any specific outreach to help manage these pandemic-driven symptoms in the workforce, or to know more about the experiences of those who may have reached out for help.

What’s your experience with pandemic-driven PTSD? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/15/21

TEFCA Will be Live in 2022

ONC hopes to have a new nationwide network open for participation in Q1 2022.

Woman’s Hospital seeks to partner with large system to boost technology access

The 165-bed Louisiana hospital is considering affiliating with another hospital to be able to implement Epic for less cost than buying it directly, which it estimates would require $200 million over seven years.

Request for Public Feedback on Draft Developer-Reported Measures

The companies contracted by ONC to develop draft EHR Reporting Program developer measures seek feedback by September 14, 2021.

Kno2 raises $15 million to accelerate its disruption of healthcare’s interoperability status quo

The network aggregrator will use the proceeds of its Series A funding round to expand its connectivity and workflows while increasing its partner base that integrate via its APIs.

Morning Headlines 7/14/21

HHS Updates Interoperability Standards to Support the Electronic Exchange of Sexual Orientation, Gender Identity and Social Determinants of Health

ONC releases the United States Core Data for Interoperability version 2.

Truveta Grows to Represent More Than 15% of all U.S. Patient Care with Three New Health Provider Members, closing Series A with $95 Million in Funding

Truveta raises $95 million in a Series A funding round and adds members Baylor Scott & White Health, MedStar Health, and Texas Health Resources.

Harris acquires ADL Data Systems, a long-term and post-acute care software solutions provider

Harris acquires ADL, which has been providing software to nursing homes and other long-term care providers since 1977.

Michelle O’Connor Named MEDITECH President and CEO

The company announces the promotion of Michelle O’Connor, which took place several weeks ago.

‘The party is winding down’: States and insurers resurrect barriers to telehealth, putting strain on patients

Telehealth visits are dropping sharply as relaxed provider laws and improved payment return to the more restrictive normal and state-by-state physician licensure again becomes a significant barrier.

News 7/14/21

Top News

ONC releases USCDI v2, which provides interoperability standards for the optional exchange of social determinants of health, sexual orientation, and gender identity.  

Reader Comments

From Shoot the Messenger RNA: “Re: post-COVID hospitalization. This is interesting work using Epic Cosmos.” A study of 8.6 million vaccinated patients using Epic’s Cosmos customer data set finds that only 0.049% tested positive afterward and just 0.018% (1,600 people) were hospitalized for COVID-19 after being fully vaccinated. Also interesting is that the study was performed  as a Dual Team Study as defined by Epic Health Research Network, where two groups are assigned the same study, work independently, and then present their work only if their conclusions are the same. Another EHRN study I noticed while looking up the first one found that most adults didn’t experience a significant weight change during the pandemic, and nearly as many patients lost weight as gained weight. These types of studies have limitations, however – they cover only patients of Epic users and researchers can see only the information that resides in Epic. The first study must have determined vaccination status as reported by patients since many or most health system patients would not have received their vaccinations from a hospital, while the second study is limited by definition to patients who had an encounter in which their weight was captured. Just about all of our inferential research data sources are imperfect due to lack of data sharing, the presence of valuable information only in freetext form, and the unreliable proxy of using billing codes to infer clinical status and activities.

From Conference Confrere: “Re: HIMSS21. Will I wish I was leaving early if attendance or energy is down?” Maybe, which is why I booked a flight out Thursday night instead of Friday morning, limiting my time in Las Vegas to three nights. I left my hotel reservation for four nights, figuring that will allow me a more leisurely departure for my red-eye flight late Thursday. But I may find that I’ve seen everything interesting in the first couple of days and end up just hanging around. Meanwhile, Las Vegas and Clark County are experiencing a mini-outbreak of COVID-19, with 1,600 new cases over the weekend, an 11% test positivity rate, and the lagging indicator of hospital admissions going up. Nevada’s vaccination rate is under 50%, visitors from everywhere are packing casinos and restaurants unmasked and undistanced, and you’ll struggle to avoid potential exposure outside the HIMSS21 protective bubble if that even works. US cases are up 94% in the past two weeks.

From Pinhead: ”Re: company pins. I’m seeing a resurgence of those lapel adorners.” Me too, even though I never understood why people would so deeply identify with the faceless company that sends them paychecks that they would be bursting to tell the uninterested world. It is fascinating to me that people who claim to be fiercely independent free thinkers pigeonhole themselves publicly by wearing garb that provides free advertising for their favorite employer, political cause, or sports team, encouraging the world to ignore everything else about them. Mrs. HIStalk reminds me that people who ask “what do you do” are really asking “what’s your job, so I can stereotype you” so they can avoid considering you to be something more than your job, so I suppose wearing a company lapel pin makes the impersonality more efficient. 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Mach7 Technologies. The South Burlington, VT company’s philosophy is based on a simple premise: legacy radiology solutions were not designed to carry healthcare organizations into the future. From its first line of code, its solutions were designed to meet the imaging needs of the entire healthcare enterprise. Its data management, workflow, enterprise and diagnostic viewing, teleradiology, PACS, mammography, and other solutions are focused on integration, workflow, scalability, and performance to ensure that imaging data can be made available wherever it is needed. Mach7 is focused on the future of healthcare. It gives healthcare organizations unprecedented technology independence and flexibility to deploy its solutions according to their needs, whether in their individual components or unified into a comprehensive end-to-end enterprise imaging platform. Its solutions bridge an organization’s legacy solutions to meet the full spectrum of multi-disciplinary imaging needs, and position them to grow, adapt, and innovate. The company’s unique approach to enterprise imaging empowers healthcare organizations of all sizes to increase their efficiency, achieve profound operational cost savings, leverage their existing IT investments, improve the experience for patients and medical professionals, and support healthier outcomes. Stop by booth #4243 at HIMSS21 to learn more. Thanks to Mach7 Technologies for supporting HIStalk.

The Clear Health Pass app – required for attending HIMSS21 – is still showing “pending verification” of my COVID-19 vaccination card, which I had to submit as a photo since by provider wasn’t listed for a direct connection. Beats me whether it will get me into the conference.

I’m watching the slow but perhaps inevitable morphing of LinkedIn into Facebook (perhaps intentionally) as I’m getting force-fed more posts about politics, lame philosophical manifestos, sports, and personal and family bragging. I can always unfollow or mute someone, but I’m wondering if the folks who “like” one of those non-business posts or add a comment to them realize that the feeds of their connections are then polluted with unwanted junk?

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

Recently formed Truveta, whose health system members sell their de-identified patient data to drug companies and providers, raises $95 million in a Series A funding round. The company announced new members Baylor Scott & White Health, MedStar Health, and Texas Health Resources.

Israel-based medical imaging AI vendor Aidoc raises $66 million in a Series C funding round.

Health IT services firm HCTec acquires managed IT solutions company Talon Healthy IT Services, which offers healthcare help desk services.

Healthcare analytics vendor VisiQuate raises a $50 million equity investment.

Harris acquires long-term and post-acute care software vendor ADL Data Systems, which it will combine with its Collain Healthcare LTPAC EHR business.  

CrossBridge, which offers technologies that address the cost and outcomes of treating patients who have chronic inflammatory diseases, acquires the PACER rheumatology disease management software from its developer Geisinger.

Sales

• UNC Health will deploy the radiology module of Sectra’s enterprise imaging solution, integrated with Epic and replacing several legacy vendors.
• Stamford Health will implement the Route solution of Appriss Health-owned PatientPing for sending ADT event notifications.

People

Olive promotes Rohan D’Souza to chief product officer.

Meditech officially confirms the months-ago promotion of President and COO Michelle O’Connor to president and CEO. She replaces Howard Messing, who remains on the company’s board.

Cerner SVP of Client Relationships Ben Hilmes, MHA joins Adventist Health as SVP / chief integration officer.

David Butler, MD (Calyx Partners) joins The Chartis Group as principal, informatics and technology.

Sonifi Health hires Mark Dyer (DaytoDay Health) as SVP of sales.

Leidos promotes James Perea, MBA to VP of VA health solutions.

Glytec promotes Jordan Messler, MD to chief medical officer.

Glenn Keet (Clinithink) joins Ciitizen as VP of HIE strategy.

Tegria promotes Justin Jozwik of its Bluetree Network business to managing director, international.

Riverside Healthcare (IL) hires Kirk Larson, MHSA, MBA (Rochester Regional Health) as VP/CIO.

Announcements and Implementations

Holy Name Medical Center’s ED goes live on Holy Name’s self-developed EHR, which is powered by Medicomp’s Quippe Clinical Data Engine. They will demonstrate the system at HIMSS21.

HealthShare Exchange and Audacious Inquiry extend the ENShare encounter notification service outside the HSX network in the Philadelphia area.

Patient transport software vendor Cheyenne Mountain Software renames itself to Motient.

KLAS’s first report on healthcare’s use of public cloud providers covers Amazon Web Services, with 11 responding organizations saying that AWS has saved them time and/or money. Respondents say that AWS offers strong product quality and development, but less-effective service and support, mostly waiting for customers to proactively engage rather than reaching out to them. Click the graphic above to see KLAS’s nicely done framework for healthcare cloud solutions. Future reports will address Google Cloud Platform and Microsoft Azure.  

Other

Stat covers the sharp drop in telehealth visits as state emergency declarations expire and insurers phase out coverage. The article notes that as doctors are once again being prohibited from conducting virtual visits for patients who are located in states where they aren’t licensed, some of the doctors are asking their patients participate in a virtual visit by driving across the state line to the first available retail store parking lot. Providers favor a telemedicine-only national license that would allow doctors to care for established patients regardless of that patient’s location.

Hospitals sue the manufacturer of the Da Vinci surgical robot for forcing them to purchase maintenance services and replacement parts at inflated prices that generate the bulk of Intuitive Surgical’s $4 billion in annual revenue. Company engineers have threatened hospitals that they will turn their expensive machines into “paperweights” if they buy parts or services from competitors, while one hospital says the company remotely shut down a machine in the middle of a surgery upon hearing that the hospital was talking to a third party about a service contract. Intuitive Surgical’s market cap is $113 billion despite a lack of evidence that machine-assisted surgeries deliver better outcomes. Axios reporter Bob Herman notes that the lawsuit is “one monopoly fighting another.”

Sponsor Updates

Blog Posts

• Use Personal Referrals to Boost Your Network and Build Your Career (Healthcare IT Leaders)

Contacts

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

Morning Headlines 7/13/21

Mytonomy Raises $25 Million Series B Funding to Transform Patient Engagement

Video-based patient engagement vendor Mytonomy raises $25 million in a Series B funding round.

HCTec Acquires Talon Healthy IT Services

Health IT services firm HCTec acquires managed IT solutions company Talon Healthy IT Services, which offers healthcare help desk services.

Charlesbank To Make A Strategic Investment In Clearlake And SkyKnight-Backed symplr

Charlesbank will make an unspecified “significant strategic investment” in Symplr.

Readers Write: Artificial Intelligence Drives a New Medication Management Philosophy

Artificial Intelligence Drives a New Medication Management Philosophy
By Erick Von Schweber

Erick Von Schweber is CEO of Surveyor Health of Foster City, CA.

There are times when advances in technology enable a radical re-envisioning of both what we do and how we do it. Medication management is at that stage, thanks to ongoing developments in artificial intelligence.

Metaphorically, will healthcare use these newfangled mechanical horses to pull its current wagon, or will it open up to radically new possibilities enabled by new technology? Several areas of AI inspire our imaginations. Let’s consider the philosophical inversions made possible.

Clinical pharmacists performing medication management interventions today spend most of their time poring over patient records, mentally integrating what they read. Then, with little time to ponder the patient’s situation, they go on to writing notes and elaborate documentation that few providers will read in entirety, if at all. Yet probabilistic AI reasoning engines coupled with semantic interoperability integrate multifaceted data without glossing over nuances, driving graphical user interfaces providing information visualizations that clinicians understand in seconds – the mental model is on-screen. The clinician can now understand the entire problem space and visually design a solution.  

In this scenario it’s not a matter of man or machine, it’s the collaboration of man and machine, each doing what they do best. Some processes will automate the routine, such as production of documentation, freeing the clinician to spend time doing what only the trained, expert human mind can. Like a financial analyst, they can use that time running what-if simulations to inform their options.

This cooperative interplay between clinician and AI opens up a potential inversion of the customary workflow. Lacking AI, medication optimization today means the clinician attends to each medication in isolation, doing their best to address any issues specific to that therapy and its relational effects with other individual therapies, one at a time (such as duplications and interactions). This traditional workflow leads to Whac-A-Mole, where a considered solution to one issue creates more issues, frequently requiring back-tracking or outright starting over. By visually modeling the entire problem space and assisting the clinician in seeing how to address it fully, AI enables a more productive workflow.

For people outside the AI research community, it’s easy to believe that ML (machine learning) is AI, but the field is far broader. Where ML is about identifying patterns in existing data sets, other areas of AI, such as AI planners, Bayesian probabilistic reasoners, and combinatorial optimization engines, imagine numerous possible scenarios – therapeutic courses of action – then figure out which are viable, which present conflicts, and which make superior tradeoffs for both the patient and the healthcare system. Human cognition inextricably involves both learning and imagination, and in AI circles, imagination, creativity, and metaphor are the vanguard. Indeed, the next steps toward creating an AGI (artificial general intelligence) that operates at near human cognitive levels are focused more on imagination.

We urge those in medication management to free themselves from the bounds that prior generations of technology have restricted them to. It’s time to imagine the future of medication management. 

Curbside Consult with Dr. Jayne 7/12/21

Sometimes a headline catches my eye, as did the one for this article about workers “epiphany-quitting” their jobs. For many, the COVID-19 pandemic has brought life into sharp focus and has accelerated decisions around what families find valuable and what can be done without. It’s been interesting to watch the flow of people both into and out of healthcare as people search for different work-related attributes: more meaning, better compensation, increased security.

One of my favorite co-workers at my former clinical employer was a seasoned professional sports mascot. He had worked for an NFL franchise before relocating and then hired on with the local baseball team. During the changes of the pandemic season, he saw the mascot workforce reduced from four to two, and despite being a pro at the signature strut and being able to do a backflip in a full-head costume, he decided he needed a change. He signed up for an emergency medical technician course and the rest is history. One of his favorite parts of being an EMT was being able to interact with people directly rather than through pantomime and oversized gestures. It was easy to see he enjoyed being around people and making them feel comfortable, even in stressful situations.

For him, moving into healthcare was about predictability and steady employment after having things pulled out from under him. It was a way to feel like he was controlling his own future, and especially with forecast shortages of healthcare workers, it’s probably a pretty solid bet. He was relatively lucky due to his age (mid 20s) and lack of family responsibilities. Not all workers are in that same situation, and I saw plenty of other co-workers leave healthcare because they couldn’t meet family responsibilities. One of my favorite medical receptionists quit because she couldn’t find reliable childcare to cover the 12-hour shifts that often stretched to 13 or 14 hours. Instead, she started providing in-home childcare, which allowed her to spend more time with her daughter as well as to help out young families in similar situations.

One of my favorite scribes was in the process of applying to physician assistant school when not only the pandemic hit, but one of her parents was diagnosed with a terminal illness. She decided to defer the application process to allow for more time with her family and also requested to go part-time at work. Although the company had a track record of refusing to allow people to go part-time unless they were enrolled in school, the pandemic forced them to adapt. Given the time needed to train a scribe and having someone willing to work in the uncertainty of a pandemic, it was a good solution for everyone.

Not everyone’s employers were that flexible, however. I watched a couple of nurses leave the workforce because part-time employment wasn’t an option and working 12-hour overnights on the COVID wards had simply worn them out. It was gut-wrenching to see these women quit jobs that they liked and would likely have stayed with had they been able to achieve flexibility, while the hospitals paid double or triple their salaries to travel nurses to cover the responsibilities.

Another friend who stayed in her ICU role out of a sense of duty and calling is still bitter about the bonuses paid to travel nurses who actually did less work than the employed nurses since they weren’t approved to use certain kinds of devices or equipment in patient care. She recently took a six-week “job swap” sabbatical where she moved to another part of the hospital and out of the ICU, which has allowed her to recharge to some degree. Still, she’ll be an empty nester in a couple of months, and I wonder if that sense of calling will still be there or if she will put the ICU behind her once and for all.

Even in healthcare technology roles, I’ve seen a change in some of the language used in promoting positions and during the interview process. Companies are more likely to advertise their flexibility and options to help workers achieve work-life balance. I see more mention of programs to allow employees to interact on non-work topics. such as support groups for employees caring for aging parents or small children, or as part of diversity efforts.

However, for every bit of flexibility, it seems another company is swinging the pendulum the wrong way. My local health system is hiring IT workers, but even though the positions are officially tagged as remote, they require relocation to the company’s headquarters state “for tax purposes.” Maybe the hospital just doesn’t want to deal with the paperwork, but they’re losing quality candidates and hiring manager friends are disgusted by the situation.

The sense that workers are evaluating their situations and deciding whether various aspects of their jobs are worth it or not is playing out across a number of industries. Due to the stressors that the pandemic has placed on healthcare organizations, however, it feels like we are experiencing it more acutely. I was having a discussion with one of my favorite revenue cycle folks recently, and in follow up she sent me an op-ed piece that I missed back in December when I was so busy trying to keep my head above water at the urgent care. It’s by Claudia Williams, former White House senior advisor and former director of health information exchange at the US Department of Health and Human Services. Although the question it asks is “Do hospitals need a chief burden reduction officer?” I would argue that the concept reaches beyond the hospital walls. Instead, we should be asking whether any organization would benefit from someone whose main role is to reduce burdens and look for ways to streamline work.

Williams cites the “must-do list of priorities for health systems in 2021” as including the following: recover the bottom line, provide frontline care for the pandemic, address health inequities, reduce provider burnout, and prepare for value-based care. Nearly all of these goals are impacted by frustrating (and often outdated) processes, multiple sets of reporting requirements that might be at odds with each other, rising costs, and the somewhat unpredictable factors of dealing with an ongoing pandemic for the foreseeable future (and perhaps indefinitely). Williams proposes a new title to join the chief experience officers, chief growth officers, and other recently created roles: that of chief burden reduction officer.

I think it’s a fantastic idea having someone who could work across multiple disciplines and service lines to identify solutions that could benefit everyone. They could unlock the potential of all the technology solutions that have been purchased over the last decade and help get rid of paper workflows once and for all. They could help streamline the patient experience as well as the clinician experience so that the two elements work together rather than at cross purposes. A chief burden reduction officer could also work with governmental agencies to help develop policies that make sense not only philosophically, but in their actual execution. No more of the “great ideas, poorly executed” that we’ve all experienced.

One of my favorite lines in the piece is this: “Health systems deeply disrespect patients when they waste their time.” The same goes with their treatment of employees (whether they call them as such or try to use cutesy titles such as associate or co-worker). An employee whose time is wasted is one who could be using that time for patient care, professional development, stress reduction, or a number of other worthwhile pursuits. Williams sums this up beautifully in the closing sentences of the piece: “All of these processes – the email, the paper, the intake form, the chart download, the fax – they are fundamentally wasteful of this beautiful human energy that we desperately need to transform healthcare. We are a nation facing multiple health crises. We need to free precious human time to address them.”

It’s a great way to think about the challenges in front of us. Who’s ready to take the leap and employ their first chief burden reduction officer? Leave a comment or email me.

Email Dr. Jayne.