Curbside Consult with Dr. Jayne 7/18/22

I spent part of the weekend hanging out with some longstanding healthcare IT friends. There was plenty of catching up to do. It was great to hear about everyone’s newest projects and what they think will be hot in healthcare over the coming years. We all used to work together, but now everyone is scattered to the winds at various health systems, consulting firms, payers, and vendors. A couple of have even retired and I enjoyed hearing about their many adventures and how much they’re enjoying not being part of the madness anymore.

Several of us have had experiences helping or parents or other relatives navigate the healthcare system in recent years, so there were plenty of conversations about the usefulness of various patient portals and how our loved ones are or are not using the information available to them. One hot topic was patients having access to their notes from medical visits. Although most of the folks I was speaking with were eager to see their own documents, probably due to the fact that we’ve spent so much of our careers dealing with EHRs and other clinical IT systems, very few of their parents show an interest in reading their medical notes.

The clinicians in the conversation voiced concerns about patients being able to see their notes and “how bad they really are” due to EHR-related note bloat. There were few concerns about patients reading things they would find worrisome or being offended by discussion of hot button issues such as obesity, smoking, alcohol use, or drug use. Nearly all felt that the benefits of transparence outweighed concerns, although one clinical informatics nurse lamented the fact that many of the clinicians that she supports write notes that can be described as “terrible,” including typos, sentence fragments, and disordered thought processes. I certainly feel for that physician’s patients if they try to access their information.

With that conversation fresh on my mind, I was happy to see a link in my email to a recent article in the Journal of the American Medical Informatics Association that looked at the impact of patient access to notes on clinical documentation. The authors set out to examine whether recent rules that require patient access to clinical notes have had unintended consequences, such as increasing physician documentation burden. They used what they describe as “a national, longitudinal data set consisting of all ambulatory care physicians and advance practice providers using an Epic Systems EHR” to specifically evaluate the length of clinical notes and the time spent documenting in the EHR.

As background, the 21st Century Cures Act language that required that healthcare organizations provide access to notes was implanted on April 5, 2021. The authors used “de-identified clinician-week level EHR audit log metadata extracted by Epic’s Signal software” to look at aggregate data from January 3 to May 29, 2021. This data covered over 340,000 unique clinicians for 21 weeks and excluded inpatient data. Analysis models controlled for the number of visits that clinicians were performing each week as well as other factors that might impact individual productivity. The authors also checked their data by looking at only primary care physicians and also by stratifying to compare physicians against midlevel providers. During the initial post-rule period, there was no statistically significant change in note length or documentation time.

Interestingly, providers spent more than 12 minutes creating each note, which is significant given the fact that a large number of visits delivered in the US are scheduled for approximately 15-minute appointment times. In the discussion, the authors acknowledge that they were looking at the potential for short term impacts and that more work is needed to evaluate whether there are long term impacts on having patients access their notes. Although I like how the authors approached the problem as well as their use of a large and available dataset, I wonder how many of the organizations in that dataset were actually releasing their notes at the time of the study. My own health system didn’t start releasing notes to patients for at least six months after the rule went into effect, although they did release content retroactively, which was a surprise to me as a patient.

Now that I have access to my notes, I look at them often. I have found their content to be largely fictional. My last preventive health visit contained two full pages of screening questions that were never asked during the visit as well as exam elements that weren’t performed. There were also inaccuracies in my responses to questions, along with what I find to be a very annoying disclaimer that the documentation “was created with voice recognition software and may contain errors or omissions.” Seriously? I can’t imagine having a patient see that information in one of my notes, and it definitely makes me think less favorably about the clinician I saw, especially since I wasn’t happy with the visit in real time.

I wonder how many patients are actually looking at notes that are available and whether they’re communicating with clinicians when they find problems. I know I don’t have time to deal with trying to get a correction, so I’m going to just let it be even though those inaccuracies will likely propagate themselves across other entries in the future. Even thinking about trying to correct it is tiresome.

I would love to see research looking at how many health systems are actually releasing their notes, how many have communicated to patients that the notes are available, and how many are encouraging patients to use the information to better their health. I suspect that the results of those kinds of efforts would be rather interesting.

The authors note that they are also unable to quantify non-note work that may have increased due to the availability of patient facing notes, such as increased patient phone calls or portal messages. I know that when I put on my CMIO hat to approve patient-facing documentation, I always try to make any default language as clear as possible to avoid creating confusion. However, I’ve seen plenty of notes where clinicians go crazy with free text and create plenty of confusion that I will never be able to influence.

Who’s ready to look at this data again, and see what it looks like 12 to 18 months into the process? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Changing Dynamics of Today’s Healthcare IT Labor Market

The Changing Dynamics of Today’s Healthcare IT Labor Market
By Mike Silverstein

By Mike Silverstein is managing partner of HIT & Life Sciences for Direct Recruiters, Inc. of Solon, OH.

Whether you are a health system, a health tech company, or an employee of either, the last two years have been a roller coaster. COVID-19 has had rippling impacts across all aspects of the HIT talent market, and the potential economic correction is compounding those ripples.

From March 2020 until June 2020, if you had a job and your employer would let you work from home as COVID-19 spiked, you considered yourself lucky. As an HIT recruiter, it was a scary time that brought me back to my start in 2008, when there were more candidates than positions, and my HIT software company clients were canceling hiring plans indefinitely.

Everyone was trying to adapt to a fully remote working situation. Health systems around the country were pausing elective positions and moving all available administrative roles from on-premise to remote. What is interesting is this felt like something very temporary at the time, but it has proved to be a historic inflection point in employees’ relationships with their employers and patients’ relationships with their doctors.

Today, if you are a health tech company and you don’t offer a virtual work environment or at least a hybrid schedule, it is almost impossible to help you find top talent. If you are a health system / health plan and don’t offer telehealth visits, live chat, virtual scheduling, online payments, and on-demand answers to clinical questions (aka digital front door), your patients/members are going to find a provider / payer that does. This consumerism dynamic signaled an opportunity for an industry disruption that attracted billions of dollars of private investment in the space and led to the craziest talent land grab I have experienced in my 14 years in healthcare recruiting.

Interviews moved to video, speed became a necessity, and companies who had coffers of fresh funding changed the playing field. If you were an experienced healthcare professional, you had an unparalleled opportunity to leverage your career and have multiple employers bidding for your services. If you were the incumbent, you quickly had to adapt from your employees being grateful for keeping them employed to figuring out what you are going to do to allow them to grow professionally, both in responsibility and finances, while allowing them to be with family and have personal flexibility.

In the past handful of weeks, I have started to feel those dynamics change once again. As inflation has driven up the price of our day-to-day and the Fed has raised interest rates to combat it, employers are starting to draw some lines in the sand. Salary offers are starting to level out and working from an office is creeping its way back into job requirements. The workforce still feels like they have the upper hand, but I think we are going to see a correction like what looms in the housing market. Companies are beginning to get advised by their investors to tighten their belt, and I have heard from several industry leading startups and growth companies that fundraising has gotten more challenging with valuations coming down to earth. From a labor market perspective, that means fewer open roles in the back half of the year, and as a result, a leveling out in terms of job offers.

As a guy who makes a living by matching candidates with employers, this is a little nerve-wracking. The good news is, I think healthcare has changed for good, and because it isn’t getting any cheaper, tech companies that can help lower the cost of healthcare, provide easier access, and improve the quality will continue to have a very bright future and need talent. I also believe at my core that talent wins the day and is always a phenomenal investment. The companies that will thrive regardless of what the economy does are the ones who hire the best people and focus on giving them great support.

There are still countless problems to solve in our industry, and the net-net is healthcare continues to be a terrific place to work, earn, and invest in as we head into the second half of 2022.

Readers Write: Four Keys to Patient Engagement for Complex Care Plans

Four Keys to Patient Engagement for Complex Care Plans
By Jeff Pigatto

Jeff Pigatto is VP and global head of Salesforce practice at Infostretch of Santa Clara, CA.

For 78% of healthcare providers, the COVID-19 pandemic has made patient engagement more important than ever, according to an industry report. Industry leaders recognize the need to improve patient engagement to reduce patient leakage, especially for those with complex care plans. Without robust engagement, patients are more likely to fall through the cracks.

To boost patient engagement, leaders need a plan. I’ll offer four key elements of a patient engagement strategy.

Use a cloud-based single system of engagement

Patients with complex treatment plans often face uncoordinated care, even when they are seeing in-network providers. Some providers, with the help of expensive back-office operations, still rely on paper-based systems to record patient information. Others may use digital tools, but they often depend on local storage and lack key system integrations. In both cases, providers can’t efficiently share patient data. As a result, the patient experience suffers.

Without streamlined data-sharing tools, patients often have to complete similar intake forms at separate care centers. That’s a tedious process,  and a vulnerable one. Complex care patients often have emotionally fraught conditions. When they have to divulge sensitive information again and again, they may grow frustrated, uncomfortable, and unsatisfied. That creates a problem for providers. Dissatisfied patients may turn to other care options or may not receive the care they need, which worsens the patient leakage problem and impacts revenue generation.

With a cloud-based data-sharing system, providers can ensure that all in-network providers have the same access to patient data. This limits duplicate form completion, meaning patients have to divulge information less often. Key software integrations can further simplify patient data management. The result for in-network providers is a streamlined patient experience that’s more compelling than out-of-network options.

Offer proactive patient interaction

A provider will often issue an in-network referral and assume patients will follow through. But patients are human. Schedules quickly change, and people can be forgetful. If providers don’t engage in proactive and consistent outreach, patients will receive slower access to the care they need. That means providers lose out on revenue. With proactive patient interaction, providers can maintain patient engagement while minimizing gaps in care.

An effective patient interaction model includes:

• Scheduling appointments immediately after referral.
• Enabling form completion before care visits.
• Providing a pre-appointment patient checklist.
• Sending regular reminders about care visits and uncompleted forms.
• Emailing patients follow-up actions after each visit.

With consistent updates, patients will know that providers are serious about their care experience. What’s more, they’ll be more likely to remember the steps needed to stay in network.

Emphasize patient education

For many complex care patients, it’s expensive to manage their long-term health. Between repeated clinical visits, treatment, and therapeutics, the costs quickly add up. Over time, patients may see providers as putting profit over care. They might start looking for a more human-centered wellness experience,  and that might be out of network. But consistent patient education can help. When patients feel empowered to manage their health, they can:

• Stabilize or improve their conditions.
• Follow their care plans more effectively.
• Reduce the risk of readmissions or emergency room visits.
• Lower the overall cost of care.

Providers benefit, too. Through patient education, they can prove they’re focused on helping patients heal. That approach could be exactly what patients need to stay with their current provider.

Here’s what patient education looks like in practice. Consider a patient who’s on a weight management plan for diabetes. Every few weeks, their provider can send plain-language materials showing how exercise helps improve insulin sensitivity. If the patient has a smart watch, their provider can suggest downloading a step-tracking app that syncs with the provider’s patient data management system. Then, the provider can use that data to keep tabs on anomalies. If the patient’s steps drastically dip between months, the provider can ask about barriers to wellness management  and help strategize solutions. The result: the patient’s long-term health will likely improve, insurance claims and out of pocket expenses will reduce, and providers can maximize their value.

The patient engagement tactics we’ve looked at so far work together to prevent patient leakage, but they can be tedious to manually implement and maintain. That’s why I recommend a fourth key element of a patient engagement strategy:

Automate patient journeys

When providers use digital tools to automate every stage of the patient journey, they can save time, reduce human error, and minimize manual labor. In the long term, automation can help providers save on labor costs. Patient journey automation might look like:

• Automatically contacting patients to schedule their next care visit.
• Automatically delivering a pre-visit checklist at Day 7 before each visit.
• Sending automated patient follow-ups at Day 1, Day 7, and Day 30 after each visit.

Automating patient journeys can support existing patient engagement efforts to help providers reduce leakage.

Pandemic pressures have made patient engagement a cornerstone of efficient access to complex care. But the pandemic is also expanding the traditional range of complex care patients. In fact, new research suggests that between 20 and 25% of those who catch SARS-CoV-2 will have some form of long COVID. It can last several months and may require a complex care plan. The prevalence of long COVID amounts to what some call a “mass disabling event.” Alongside existing complex care patients, providers must invest in a long-term patient engagement strategy that accounts for an expanding chronically ill population.

HIStalk Interviews Diana Nole, EVP/GM, Nuance

Diana Nole, MBA is EVP/GM of the healthcare division of Nuance, a Microsoft Company, of Burlington, MA.

Tell me about yourself and the company.

I’ve been with the company just a little over two years, but I have been around healthcare IT for about 15 years, which makes me a little bit further along than just a novice, I like to say, because it’s such a complex industry. Since we last spoke, Nuance has become a Microsoft company. Nuance is a technology pioneer, focused on conversational AI and ambient intelligence and working on how to put things into the intelligence, into the workflow. We are heavily focused on reducing the administrative burden of clinical documentation. Our offerings are used widely throughout the US and globally.

Microsoft’s Cortana doesn’t have the adoption of competing voice assistants from Amazon, Apple, and Google. Was that part of its interest in acquiring Nuance?

There were probably a few levels of interest. We are heavily into the deep workflow of clinicians and the patient experience. We try to understand heavily with our customers and our partners what’s going on in terms of patient care and this focus on the Quadruple Aim. We have a deep presence. We are in 77% of the US hospitals and I think we were quoted as being in 80% of radiology. In healthcare, it’s about how the technology is being used to actually enhance patient experience, physician experience, et cetera. There was the actual technology that we have, but even more so, the relationships that we have and the clinical care. Then, the deep relationships that we have with our EHR partners and other partnerships were very much of interest to them.

Now that Nuance and Cerner are owned by highly competitive technology giants, how will Nuance’s relationship with Cerner customers work?

We deeply value these relationships, as you can imagine. Our solutions have to work within the workflows that our physicians, nurses, and radiologists use. We have had ongoing conversations with Cerner since the acquisition. Clearly, we are deeply committed. We have continued to advance our solutions, such as DAX integrating with Cerner’s virtual scribes. There’s a lot of opportunity here, and certainly we don’t want to disrupt that.

That has been a very key theme of our conversations with Microsoft, that they value that. They are deeply committed to their partnerships and the systems integrators that they work with. That’s a core backbone of who they are. We continue to advance — whether it’s Cerner, Athenahealth, Epic, et cetera — these relationships, because the only way that we can be efficient in the way that we deploy our technology is to do it with them.

Oracle says that it will use its own voice AI product as the primary user interface to the Cerner clinical systems it now owns. What challenges do you see in that approach?

We obviously always know that there will be competition out there. We have been at this for a long time. Medical technology and terminology is very different from just straight conversation. We have invested deeply over many, many years and have many years of experience. We respect that others will come along, and that’s why we constantly are working on our own technology advancement and why we have moved from our medical technology and things like Dragon Medical, which is used by so many people, into more of the ambient environment, which is even more complex. You have to keep pushing yourself, and competition helps you move along because you need to stay ahead of that if you are going to survive and be effective.

I can’t speak specifically to what Oracle’s plans might be, but certainly for us, we are deeply invested in continuing to advance our Dragon portfolio, our DAX portfolio, and other things with our partnerships that we have and investing in the technology. Now we have a phenomenal owner in Microsoft that can help us advance those solutions while also having the cloud infrastructure and cybersecurity infrastructure that they bring to the table to help complement the first-party applications that we have.

What new capabilities does the cloud bring to healthcare?

We have deeply been invested in cloud. The big reason that we are trying to help our healthcare customers move into the cloud is that, historically, we have had a lot of on-premise solutions. It as always challenging to do upgrades, and you want to get the innovation out there as fast as possible. But we also know healthcare has significant worries about privacy and security. We are evolving at a good pace. Certainly with someone like Microsoft, we have deep investments on that side. Once you get everything in the cloud, then we have a good infrastructure to start to unlock other kinds of use cases for the information that resides within the cloud, under the constraints of doing what we’re supposed to be doing as good stewards of the data.

As we have started to think about the combination of our two companies, we think about analytics, reporting, and how you do communication. A lot of things in healthcare are about getting the communication to the right player and the care team. How do you use communication tools to be able to do that? 

Also, things that help enable different kinds of care settings. I’ve heard people talk about the hospital at home. We certainly have seen virtual care advance during COVID, not just with telehealth, but other types of thinking and capabilities. That is helpful because it tries to get at a better physician experience, a better patient experience, while also hopefully reducing cost and not sacrificing quality at all.

Hospital consolidation that creates larger, more tech savvy health systems has generated ideas around scaling patient engagement, call centers, and other centralized consumer-facing technology. Where do you see that progressing?

I think we learned a lot during COVID about what people would accept. We have a tremendous ways to go with consumerization and what you can do to engage patients while also recognizing that you have to deal with accessibility. Not everybody has access to things such as the internet. We also have learned that, so we have to be careful. We have made advancements in basic blocking and tackling, such as outreach around reminders. As a patient, come in and get your mammogram, get your annual exam, get your preventative care. That makes a huge difference. But other settings are starting to be considered, such as better management of clinical trials with a virtual patient clinical trial cohort.

With regard to the care setting, not just telehealth, what can you do in monitoring a patient with a more chronic condition at home? Maybe that is more integration with med tech, home devices, and things where you can identify if and when a patient needs to come in for a visit or to have follow-up. Always trying to prevent that rising risk of issues with the patient. There are definitely opening thoughts around other areas beyond just the typical reminders and telehealth. more sophisticated things that are going to be coming.

Voice assistants are being enabled to support consumer health needs at home, including remote monitoring. How do you think that will progress?

Voice assistants, definitely. We probably have seen more initially on the roadmaps with physicians. The physicians can use “Hey, Epic” or “Hey, Cerner” or “Hey, Dragon — bring up this, bring up that.” It’s much quicker than clicking, because you can speak faster than you might type or click certain things.

But you are also right that in a conversational way, it is easier for a patient who doesn’t know exactly what they’re supposed to be looking for, or how they get basic information. We’ve had some solutions where it’s just simple things that the patient is looking for, such as, “Remind me about this situation that I should be taking care of,” or “Where is the valet parking at the appointment I’m going to?” Just basic interactions that used to flood the healthcare system with basic conversational questions. Those kinds of things can be done now through easy to use, consumer-oriented types of applications, but specifically for healthcare.

DAX has been out for a couple of years. How is it being used and what work remains?

It has been about two years since DAX was announced during COVID. It almost matches the exact timeline. Definitely we would view it as being at the Slope of Enlightenment, where our customers and partners are proving the benefits and use cases within their organizations. Initially, people would start with groups of 25 physicians. Now we are starting into the hundreds, and we have implementations that are well into the thousands. What they are trying to prove is who the right user for it is and where the most opportunity is.

We started out with certain specialties where we thought it would be easy to use and produce a good ROI. We have seen that family medicine and internal medicine have more of an opportunity to use the system than anywhere else. That is where the burden of clinical documentation creates the highest levels of burnout and where we have a shortage, either already in existence or coming.

We published some great opportunities with our customers on what they are seeing. They get better patient experience input, since the patient feels like the physician is talking to them face to face and focusing on them. They understand what they are supposed to do when they leave a visit. As to the physician experience, they are less burned out. They have more of their own time. They can get home. They can take on more patients if they want. Even though it has been two years, we are still in the early days, but definitely have proved a significant ROI for those who are using it.

What has changed in the months since the acquisition closed and what changes do you expect?

I would say that not a lot has changed. At Nuance and at Microsoft, we continue to remain focused on our customers. We continue to deepen relationships with our EHR partners. We are now part of the Microsoft organization. We are a Microsoft company. What we have done since the close in March is to focus on what our shared vision looks like. Our customers are looking for that. They are optimistic. They realize the big, complex challenges that face healthcare, and they really want to have Nuance and Microsoft look together at how can we enhance the ability of clinicians to care for their patients and deliver better outcomes, where technology helps to enable it instead of getting in the way.

We are focused on that right now, and we are involving customers and partners in those conversations. When you think about the combined power of Nuance and Microsoft, where do you see opportunities, and where do you think we should work on this? That’s what we’re focused on, so that we can begin to unlock some of the opportunity that spans both of our companies over the course of the next year.

Another thing we are excited about at Nuance and Microsoft is a partnership with The Academy around an AI collaborative. It’s early days, just announced recently, but it’s an effort to bring together clinical and operational executives not only from provider organizations, but from payer, med tech, and life sciences. We will create a dedicated sandbox for us to experiment with AI and have them, as users of AI, tell us where it will work or not work to guide some of this collective vision that that we are working on.

Morning Headlines 7/18/22

Senior Staff Gave Inaccurate Information to OIG Reviewers of Electronic Health Record Training

A VA OIG report says that VA project executives provided it with misleading information about employee training on Cerner.

Scoop: Veritas buys RCM firm Coronis Health

Axios reports that private equity firm Veritas Capital has acquired physician billing and RCM company Coronis Health, reportedly with the intention of buying another privately held RCM company and combining the two.

R1 RCM Announces 10-Year End-to-End Revenue Cycle Management Partnership with Sutter Health to Drive Improved Financial Performance

Sutter Health signs a 10-year RCM outsourcing contract with R1 RCM, which will hire 1,150 Sutter employees.

Do Cancer Centers Push Too Many Tests?

A New York Times review of 600 cancer center websites finds that they often tout the benefit of tests, often highly profitable radiology exams, in ways that conflict with medical evidence and recommendations.

Monday Morning Update 7/18/22

Top News

A VA OIG report concludes that the VA’s use of an “unknown queue” in its Cerner system caused multiple events of patient harm in which orders failed to reach their intended care location. Notes from the report:

• The system failed to deliver 11,000 orders in which clinicians chose a service location that didn’t match the type of service that they were ordering.
• The system did not notify the clinicians that their order had not been delivered, and in fact assured them that their order had been accepted.
• The VA learned of the unknown queue’s existence when it opened its first Cerner trouble ticket about the problem four days after go-live, after which the VA instructed staff to monitor the queue and cancel and re-enter the problem orders.
• Cerner says that a a VA leader had approved the use of the unknown queue in January 2020, but that leader and their supervisor say they weren’t aware of it.
• Cerner created a provider alert for their undelivered orders in February 2022, but the VA said that the solution wasn’t adequate.
• The OIG did not accept the response to its report from VA Deputy Secretary Donald Remy because it failed to address the report’s key finding that patients were harmed.
• Remy says that Cerner and the VA were both aware of the queue’s existence before go-live, but OIG says it was provided with no evidence to support that statement and that users weren’t informed about the queue until a year after go-live.
• OIG says it it is “troubling” that Remy absolves Cerner for failing to educate VA about the unknown queue and instead blames VA users for the negative outcomes it caused.
• OIG also notes that both the Deputy Secretary and EHRM IO executive director were aware of the patient harm that resulted, but in their testimony to Congress, they insisted that no harm had occurred.

A second new VA OIG report looks at the VA’s Cerner training:

• VA project executives sent misleading information to OIG in to a “careless disregard for the accuracy and completeness of the information.”
• VA showed OIG a training evaluation plan without disclosing that the plan had not been reviewed, approved, or implemented.
• OIG was given a slide that showed the user proficiency pass rate at 89% instead of the actual 44%, then explained the error as being due to removing a small number of outliers who had taken and failed the test up to 29 times. VA had not calculated the numbers until it received OIG’s request.

HIStalk Announcements and Requests

It’s pretty much an even split between C-level executives working from home or from the office. I’m surprised – I thought more of the C-suite would have returned to the office.

New poll to your right or here: How worried are you that your employer will lay you off, demote you, or force you to relocate in the next 12 months?

Thanks to new HIStalk Platinum Sponsor West Monroe, which is upgrading from Gold. The digital services firm was born in technology but built for business, partnering with companies in transformative industries to deliver quantifiable financial value. It believes that digital is a mindset—not a project, a team, or a destination—and is  something that companies become, not something they do. That’s why it works as diverse, multidisciplinary teams that blend management consulting, digital design, and product engineering to move companies from traditional ways of working to digital operating models and create experiences that transcend the digital and physical worlds. Thanks to West Monroe for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Private equity firm Veritas Capital acquires Coronis Health, which offers physician billing and RCM. Axios speculates that Veritas will acquire one of several potentially available privately held RCM company and combine it with Coronis Health.

A fascinating Brookings report looks at Medicare Advantage insurance market, which is good timing since the eye-popping paper valuations of some tech-focused players are being shredded in a more scrutinizing stock market:

• MA represents 46% of all Medicare beneficiaries.
• Two-thirds of enrollment is concentrated among five big insurers – UnitedHealth Group, Humana, CVS/Aetna, Kaiser Permanente, and Anthem.
• These large companies have other businesses that provide services to their MA plans, such as Humana-owned Kindred’s home health and hospice services and three of the five that operate pharmacy benefit managers. Profits in those related businesses are shielded from medical loss ratio requirements, which places smaller insurance competitors at a disadvantage..
• Nearly all of the plans bid rates that are lower than Medicare fee-for-service, but plan payments are 104% of Medicare spending in generating net profit margins of 5%. However, big insurers have accounting flexibility when they operate multiple insurance product lines and related businesses that sell services to their MA plans, so their true profit and pricing competitiveness are hard to determine.

Sales

• Bedrock Management Services chooses CareCloud Remote solution for home healthcare practice groups, which it will implement at 33 locations in seven states.
• Starting Point Behavioral Healthcare will implement Owl’s measurement-based care platform,  which offers evidence-based measures and predefined measure bundles to give clinicians actionable insights.
• Sutter Health signs a 10-year contract to make R1 RCM its exclusive provider of enterprise revenue cycle management services, with 1,150 Sutter employees being assigned to R1 RCM.

People

Tanner Health (GA) promotes Bonnie Boles, MD, MBA to SVP/CMIO.

Joe Bajek (Centura Health) joins Lifespan as VP/CTO.

Other

So many lessons to be learned here. A company that runs a video game operator in which players can earn cryptocurrency by battling Pokemon-like characters loses $620 million in crypto when one of its engineers falls for a fake job offer on LinkedIn. North Korea-based hackers posed as job recruiters on LinkedIn, got a bite from an engineer at game developer Sky Mavis, took the engineer through several rounds of interviews, and then sent him a generous offer letter in the form of a PDF that was loaded with spyware that gave the hackers access to the company’s blockchain network.

Sponsor Updates

• Volunteers from Arrive Health (formerly RxRevu) help Denver-based mental health provider WellPower prepare its ADA-accessible garden space at its Dahlia Campus for Health and Well-Being Market Farm.
• Quil publishes a new white paper, “Bridging the Gap Between Patient Engagement Solutions, The Provider Experience.”
• Relatient will offer TriZetto Provider Solutions customers access to its Dash patient scheduling and engagement suite of solutions.
• Talkdesk publishes a new report, “The Future of AI 2022: Progressing AI Maturity in the Contact Center.”
• Clearsense posts “Top 5 Spots to Check Out in Madison at the Epic UGM.”
• TigerConnect releases a new episode of The Connected Care Team Podcast, “A Conversation on the Next 10 Years of Healthcare Transformation.”

Blog Posts

• 4 Signs an Urgent Care Needs to Improve Their Patient Experience (PatientBond)
• 3 Questions to Ask Before Choosing a Healthcare ERP System (Pivot Point Consulting)
• Northwest Health Adopts Artificial Intelligence Technology to Enhance Maternal and Fetal Safety (PeriGen)
• Best Practices for Healthcare Software Deployment (PerfectServe)
• Celebrate the “Insiders” of Healthcare Value During Value Analysis Week (Symplr)
• Accelerating the APM Adoption with Rural Providers (Premier)
• Unpacking HIMSS Research Insights (Redox)
• Patient-Centered Marketing: 7 Strategies to Drive PT Self-Referrals (WebPT)
• Identity is More Than a Hospital Bracelet: How to Get Person Data Right Every Time (Verato)
• Not All Interventions Are Created Equally (Zynx Health)

Contacts

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

Morning Headlines 7/15/22

Making Electronic Health Records Both SAFER and SMARTER

Informatics leaders call for expanding use of the SAFER guides to align health systems and EHR vendors in improving safety and usability, and for developing a similar set of SMARTER guides to protect the cognitive attention of clinicians.

Healthcare Triangle Announces Closing of $6.5 Million Private Placement

Healthcare cloud and data transformation vendor Healthcare Triangle closes a $6.5 million private placement.

The New Electronic Health Record’s Unknown Queue Caused Multiple Events of Patient Harm

A new report from the VA’s Office of Inspector General confirms that an “unknown queue” within the VA’s Oracle Cerner system led to 150 adverse patient events.

HPG, a Leader in EHR Technology Integration, Acquires HIT Consulting Services Provider HDS

EHR consulting firm Healthcare Performance Group acquires competitor Health Data Specialists.

Canvas Medical Achieves ONC Certification, Raises $24MM to Power Clinicians and Developers Building and Scaling Digital Health Companies

EHR and developer tools vendor Canvas Medical raises $24 million in a Series B funding round.

News 7/15/22

Top News

A JAMA viewpoint article by informatics leaders Kevin Johnson, MD, MS and William Stead, MD calls for expanding use of the SAFER guides to align health systems and EHR vendors in improving safety and usability, but also to develop a similar set of SMARTER guides to protect the cognitive attention of clinicians.

Broad topics include the use of collaborative documentation, designing workflows to minimize interruption, and aligning decision support to role and task.

The authors summarize:

The term electronic health record is a misnomer. The EHR is a complex sociotechnical infrastructure for automating clinical and administrative workflows within a healthcare facility or system. It is not designed primarily to capture and present a patient’s record as efficiently and effectively as practical. It is not an additive technology, such as a new imaging modality, that works within established practice workflows. Connecting EHRs to other health system technology requires complicated interfaces; connections among health systems require even more work. Second, the EHR has many stakeholders … in the US, requirements for reimbursement, regulatory compliance, and administrative workflow automation often take precedence over clinical efficiency and effectiveness … clinical teams are challenged by repetitive documentation, alert fatigue, increased workarounds, and decreased data quality.

HIStalk Announcements and Requests

My infrequent health system encounters give me little patient exposure Epic’s MyChart, but my recent “is this COVID or something else” visit to an academic medical center’s urgent care clinic showed me how far use of MyChart has progressed. The urgent care provider notes and billing information were posted quickly, my meds list is correct since she reconciled it during that visit, appointment scheduling looks easy even though I didn’t use it, messaging is handy, and record-sharing appears easy with downloading or sending records or enabling Share Everywhere. MyChart is one of few health-related apps I’ve used that not only provides immediate value, but is just as slick and functional as anything I’ve used outside of healthcare and depth of its capabilities, which probably varies by customer site, is impressive.

Webinars

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

Acquisitions, Funding, Business, and Stock

EHR consulting firm Healthcare Performance Group acquires competitor Health Data Specialists.

EHR and developer tools vendor Canvas Medical raises $24 million in a Series B funding round.

Healthcare Triangle closes a $6.5 million private placement.

Sales

• Northwell Health chooses Google Cloud as its preferred cloud platform and says it will use the platform’s AI/ML capabilities to implement clinician decision-making support.
• Infectious disease laboratory testing vendor HealthTrackRx will implement Shadowbox to connect its lab systems to customer EHRs.

People

Xealth hires Joe Sedlak, RN, MBA (Health Recovery Solutions) as SVP of sales and Laurance Stuntz (Massachusetts EHealth Institute) as SVP of customer success.

Announcements and Implementations

A study involving GetWell’s remote patient monitoring technology finds that its use by COVID-19 patients resulted in lower hospitalization rates, ICU use, and length of stay.

Dubai’s Medcare Women & Children Hospital goes live on InterSystems TrakCare.

CHOP genomics researchers develop a phenotype algorithm that analyzes EHR information and biobanking data to identify patients who have ADHD alone versus ADHD with comorbid conditions.

Meditech announces Meditech Live, a customer leadership conference that will be held in Foxborough, MA September 20-22.

Government and Politics

FDA Commissioner Robert Califf, MD says that US medical product evidence generation is “mediocre” once medical product development progresses beyond the early phase. He says that “everyone in the United States has an electronic health record packed full of data that could be used to do studies very inexpensively.” He cites the astonishment expressed by some that FDA’s follow-up study on questionably approved Alzheimer’s drug Aduhelm would take nine years, saying that the system should be able to quickly generate solid evidence to support post-market studies.

AMIA and the American College of Medical Informatics call for new privacy regulations following the Roe v. Wade decision that would protect digital health data from subpoena and areas that fall outside of HIPAA such as apps, websites, search behavior, and consumer location data.

Other

A report concludes that England will need to create 40,000 more hospital beds by 2030 to be able to deliver pre-pandemic standards of care to an aging population. Per-person hospital capacity has halved in the past 30 years, with high bed occupancy and overtaxed ambulance and ED services. Report publisher Health Foundation also calls for remote patient monitoring and boosting social and community care options to allow timely hospital discharges.

MIT researchers create a publicly available set of 2,000 clinical questions whose answers physicians are most commonly seeking when using their EHR, hoping to reduce the time doctors interact with the EHR user interface by extracting the answers automatically. Initial results were poor because the evaluation questions that were used were not good ones, so the team is training a model that will generate thousands or millions of good clinical questions that will then be used to train a new model to answer them. [insert your witty observation here]

A study finds that employees in their 20s are pushing hardest for a return to in-office work, worried about the lack of community, mentorship and networking opportunities, and the physical space needed to do their jobs. Some of them are turning down job offers that call for remote-only employment. Older workers are happier with WFH because they have bigger homes, a well-establish group of friends, the freedom to transport their children, and a strong desire to avoid time-wasting commutes from the suburbs. One author says that hybrid policies that don’t mandate specific in-office days of the week can morph into remote-first work because people who show up find that colleagues and office energy are not there. One CEO says that the Great Resignation was really just people changing jobs because of their work preferences. An unintended consequence may be that younger employees work from the office, while older workers are allowed to WFH in the suburbs since companies can’t satisfy both groups with a single policy.

Sponsor Updates

• Medicomp Systems releases a new “Tell Me Where It Hurts” podcast featuring Nick van Terheyden, MBBS of ECG Management.
• EClinicalWorks partners with HealthEfficient to support its 40-plus member health centers across the country.
• Everbridge adds Service Intelligence to its Digital Operations offering to help customers accelerate IT incident response, reduce time-consuming unplanned work, and maximize the value of digital service.
• Meditech will host Meditech Live September 20-22 in Foxborough, MA.
• Cerner describes how Fisher-Titus Medical Center replaced its hastily implemented early-pandemic virtual visit system of IPads and MIcrosoft Teams with an integrated platform from Amwell and Cerner, where a virtual rooming process mirrors in-process workflow as clinicians launch virtual visits as a video window within a patient’s Millennium chart.
• Net Health announces that its rehabilitation outcomes management system, Foto Patient Outcomes, has been used in the 127th clinical research study published in a peer-reviewed medical and rehabilitation journal.
• Netsmart releases a new CareThreads Podcast, “Unlocking Success in Palliative Care.”

Blog Posts

• A Different Point of View: The Key to EHR Usability – Clinically Responsive Workflows (Medicomp Systems)
• Integrated, Whole-Person Care – A Data-Driven Approach to Transform Payers into Care Orchestrators (Diameter Health)
• Avoid the Telehealth Cliff: Managing Enterprise Risk in Virtual Care (EVisit)
• Combining AIOps with Service Intelligence: Critical for Digital Service Uptime (Everbridge)
• 3 Ways a Neutral Zone Could Propel Personalized Medicine: Real-Time Example of Data Collaboration from Roche (Healthcare Triangle)
• EHR Optimization – 3 Crucial Steps to Ensure Success (HCI Group)
• 5 Tips to Build Value Through In-Application Health Education (Healthwise)
• What is Advanced Scheduling? Q&A with Dave Johnson (Healthcare IT Leaders)
• 4 Simple Steps to an Effective Analytics Strategy (Medhost)
• Turning Solution into Strategy with your CMDB (Optimum Healthcare IT)
• Giving clinicians the tools for safer opioid prescribing (Meditech)
• Functional Outcome Measures in PT – Best Practices (MWTherapy)
• Powering AI in radiology: The role of structured data (Nuance)
• The alchemy of care variation (Nordic)

Contacts

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

EPtalk by Dr. Jayne 7/14/22

I spent some time on Wednesday attending a deep dive on “The Platform Revolution Comes to Healthcare” as part 2022 MIT Platform Strategy Summit, which is taking place in the Boston area this week. The initial speakers, Vince Kuraitis and Randy Williams, spoke to what they described as four healthcare platform megatrends:

• Synergy. Platforms advance (and are advanced by) four key healthcare trends – value-based care, consumerism, interoperability/data sharing, and home/virtual care.
• Investment in digital health is fueling platform growth.
• Platforms are shaping new operational ecosystems.
• Platforms are transforming the competitive landscape in healthcare.

One of the highlights was the keynote fireside chat with Jonathan Bush, who described his experiences in building healthcare platforms. He had an interesting analogy about Dudley Dursley in the Harry Potter books, likening healthcare to Dudley. Healthcare isn’t evil, but it still kills people every year, so “we jack the safety net up so far” that “there’s no ability to move about the cabin” and trying to figure out how to innovate without violating the social safety net.

He refers to his former clients at Athenahealth as “kooks” with great affection. He notes that in healthcare, the demand curve doesn’t function the way that it does in conventional businesses, because there really isn’t a choice to not buy the service and keep the money. He notes two things that have shifted the demand curve – the COVID pandemic, which has shifted acceptance of virtual-first approaches, and the ability to assemble robust tech stacks.

I chuckled when he described in-person care as “lumbering in and taking your pants off and sitting on waxed paper every three months.” Jonathan has certainly mellowed over time, and I always enjoy hearing his thoughts. It will be interesting to see how Zus Health plays a role moving forward.

Speaking of healthcare transformation, we’re approaching the point at which health plans and insurers have to provide pricing information to the public. As of July 1, CMS required those organizations to provide machine-readable files for in-network rates and allowed amounts respective to various medical charges. Starting in 2023, they must also provide online price comparison tools to allow patients to estimate their individual payment portion for a list of over 500 items and services. In 2024, they will have to provide price comparison tools covering all services. Organizations that fail to comply face a fine of as much as $100 per day for each violation for each affected enrollee.

I’m all for empowering patients to understand the costs and options for various services, but publishing this data doesn’t take into account the differences between the same services performed at different facilities. These nuances often inform how physicians order their tests. For example, I am extremely high risk for breast cancer, to the point where I could easily qualify for preventive surgery. Prior to undergoing consultation with an expert, I used to have my mammograms at an independent general imaging facility because it was convenient, the costs were low, and a preliminary reading was provided before I left the building.

However, after having multiple consultations with nationally known experts in the field, coupled with genetic testing, I switched to having my mammograms (and now MRIs) performed at a more costly facility that has subspecialty radiologists interpreting all the studies. The average patient doesn’t understand that subtlety, and with the devaluing of comprehensive primary care in the US, I doubt those kinds of conversations are going to be happening in the exam room.

Speaking of genetic testing, I was excited to see the announcement that Myriad Genetics has partnered with Epic to make genetic testing more nearly seamless for patients and providers. My own Myriad testing several years ago was ordered with a daunting-looking triplicate paper form, where the medical assistant had to transcribe dozens of data points that already existed in the EHR. Results came back on paper, which the office had to scan into the chart. They were supposed to mail me a paper copy, but somehow couldn’t get it out the door, so after weeks of delay and begging on my part, I finally received a PDF version of the scan, minus the pretty color that I’m sure was in the original paper result. Less than ideal, but I’m excited that future patients will have better options for receiving their results and that physicians will be able to fully explore the value that discrete data brings.

Once upon a time during one of my work trips, I became a patient at Mercy. They recently sent an email to patients with “MyMercy” MyChart accounts asking them to take a survey about a new feature. Apparently  they are evaluating the possibility of implementing Epic’s MyChart Bedside capabilities and wanted patient input.

Having been on the health system side of healthcare IT, it’s often difficult to prioritize initiatives unless they are regulatory or otherwise mandated. Understanding how patients would use or not use a potential new feature seems prudent given the limited resources available to most IT teams. Survey participants were asked to rank a list of features based on how useful the participants thought they would be during an inpatient stay. I’m not a regular consumer of care through Mercy, but I did appreciate the outreach. I’ve got some contacts from residency that work there so will be interested to see if I can find out how the results are being used to make decisions.

Former telehealth darling (and now telehealth pariah) Cerebral tried unsuccessfully to recruit me before its fall, but I’ve ended up on one of their mailing lists. The company is conducting an all-out messaging campaign to explain its new focus on clinical quality and its vision for comprehensive mental health care. Putting on my primary care hat, I’m unimpressed by their messaging. It’s going to take a long time for them to overcome the perception that they have been prescribing controlled substances like someone giving out candy at Halloween.

Since I care for children, another physician recently asked me for my thoughts regarding the “right” age for her personal child to get a cellphone. This is often a hot topic around the neighborhood as well, with every child seemingly stating that “everyone else has one but me.” There’s a growing body of data demonstrating that mobile devices are harmful to mental health. One physician I refer to stated that smartphones are little more than “dopamine dispensing slot machines.” Discussions  at the recent Endocrine Society meeting highlighted issues with smartphone-associated behavioral issues, sleep disruption, and obesity.

Most adults I know don’t have the ability to separate from their phones, so it’s not realistic to think that the relatively underdeveloped brains of children would make it any easier for them. The article links to a number of publications in the medical literature regarding cell phone and screen use. If you’re a parent of children or adolescents, or if you are concerned about your own dependence on mobile devices, it’s worth a read.

Do you think that constant smartphone access and the prevalence of social media is making the world a better place or consigning us to a dreary future? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/14/22

Brightline Closes $10 Million Extended Series C Financing from Northwell Health as Demand for Family Behavioral Health Care Soars

Pediatric and family-oriented virtual behavioral healthcare company Brightline adds a $10 million investment from Northwell Health (NY) to its Series C funding round, bringing its total to $115 million.

Alaska DOH issues RFP for statewide health information exchange services

The Alaska Department of Health seeks proposals for a statewide health information exchange project budgeted at $6 million for the first two years.

Electronic Caregiver buys Las Cruces Tower for $8.9 million

Remote patient monitoring and virtual care company Electronic Caregiver acquires the building where it is headquartered for nearly $9 million to accommodate the addition of 770 employees over the next five years.

Morning Headlines 7/13/22

UHG’s Optum and Red Ventures launch consumer health JV

UnitedHealth Group’s Optum Health and Red Ventures form RVO Health, which will include consumer-facing health and wellness websites — such as Healthline, Psych Central, and Healthgrades – along with Optum Store and virtual coaching platforms.

Particle Health Raises $25 Million to Accelerate Platform Growth

Clinical data exchange API company Particle Health raises $25 million in a Series B funding round.

Fold Health Raises $6M in Funding

Fold Health, a San Francisco-based startup developing technology for primary care practices, raises $6 million.

News 7/13/22

Top News

UnitedHealth Group’s Optum Health and Red Ventures form RVO Health, which will include consumer-facing health and wellness websites — such as Healthline, Psych Central, and Healthgrades – along with Optum Store and virtual coaching platforms.

Red Ventures owns internet properties such as CNET, The Points Guy, TV Guide, ZDNet, and Bankrate. It acquired Healthline Media in July 2019 and Healthgrades.com in August 2021.

Optum Health operates a network of primary care, surgery, and urgent care centers.

Webinars

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

Acquisitions, Funding, Business, and Stock

Enterprise performance management software vendor Syntellis Performance Solutions acquires Stratasan, which specializes in healthcare market intelligence and analytics for hospitals and other healthcare organizations.

Clinical data exchange API company Particle Health raises $25 million in a Series B funding round.

Sales

• Northwell Health selects EVideon’s Vibe Health interactive bedside technology, including Engage TV and Insight digital whiteboards.
• TriZetto Provider Solutions will offer its customers Relatient’s Dash suite that includes contact center scheduling, patient self-scheduling, reminders, messaging, and chat and digital patient intake.

People

Sage Health hires Wayne Sass, PhD (Optum) as CTO.

Scott Gildea, MBA (Leidos) joins Nordic as VP of enterprise technology transformation.

TriHealth CIO Cathy French, MS will retire in September after nearly 44 years with the Cincinnati-based health system. She started out as a staff nurse and then became director of IT health system products in 1979.

Announcements and Implementations

Northwest Health (IN) rolls out PeriGen’s PeriWatch Vigilance maternal-fetal early warning system within its Birthing & Family Care Centers.

PrimaryOne Health implements Bluestream Health’s virtual care services across its 11 locations in central Ohio.

Hansen Family Hospital (IA) and affiliates implement mobile check-in technology from Epion Health.

Mass General Brigham will expand its hospital-at-home program and has hired a home-based care president who formerly worked for for-profit Kindred at Home. The program expects to serve 200 remote patients versus today’s 25 and will expand employee headcount from 800 to 1,000.

Wellness app vendor Happify Health renames itself Twill Health and describes its expanded offerings as, “By combining digital therapeutics, well-being products, community-based care, live coaching, and clinician-trained AI, Twill intelligently guides each person to the care they need, when they need it, in the way they want.”

The six-week CHIME Healthcare CIO Boot Camp – Digital will start on August 15, 2022. The program is open clinical informatics leaders or those who work for provider organizations, with CHIME membership not required.

Privacy and Security

Virginia Commonwealth University Health System notifies 4,441 organ donors and recipients of a data breach that enabled their PHI to be viewed by other patients through the health system’s patient portal.

A California newspaper’s opinion piece says that patient privacy will change on January 1, 2024, as a new state law — mostly addressing expanding Medicaid to undocumented immigrants — will give all practitioners access to all of a patient’s data, with no exception for behavior health and abortion visits.

Ransomware groups create a searchable database of all the data they have stolen from hacked companies who haven’t paid their demanded ransom. It gives other hackers access to passwords and confidential information and lets patients know that their information has been exposed, pressuring the hacked companies to pay up.

Other

Amazon’s moonshot project is developing cancer vaccines in partnership with Fred Hutchinson Cancer Center and is recruiting patients for an FDA-approved clinical trial of personalized vaccines for breast cancer and melanoma. Amazon says it is contributing scientific and machine learning expertise.

Sponsor Updates

• EClinicalWorks releases a new customer success story featuring Ninth Street Internal Medicine, “Healow Pay: Improving Collections, Reducing Phone Calls.”
• Diameter Health publishes a new white paper, “The Strategic Role of Clinical Data in Risk Adjustment.”
• Estonia’s Pildipank expands its relationship with Agfa HealthCare by moving the shared PACS to the Enterprise Imaging Platform.
• Dutch care home provider Coloriet renews its service contract for Ascom’s TeleCare IP, smart sensoring, and mobility solutions.
• Bamboo Health joins the Florida Behavioral Health Association as a corporate member.
• Oracle Cerner has increased the total number of beds contracted outside of the US for the second consecutive year.
• CHIME releases a 30^th anniversary podcast, “Innovation with Tim Stettheimer, 2010 Board Chair.”
• Arcadia makes its research data available through AWS Data Exchange.

Blog Posts

• High Quality Clinical Data Increases Risk Score Accuracy for Health Plans (Diameter Health)
• Truth about Browser Extensions with Cloud Applications including AdvancedMD (AdvancedMD)
• Overdose prevention centers and the impact of mental health data (Arcadia)
• Leveraging internal audit to minimize risk of third-party vendors in healthcare (Baker Tilly)
• EHRs are Slowing Health Tech Innovation (Bravado Health)
• Oncology Integrations in Meditech Ambulatory: 7 Focus Areas for Team Collaboration (CereCore)
• The Triple Aim of Health Care (ChartSpan)
• 10 Common Challenges Facing Epic IT Teams (CTG)
• How Health First makes Hospital at Home available to everyone (Current Health)
• Florida is the Perfect Place for Early Birds (EClinicalWorks)

Contacts

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

Morning Headlines 7/12/22

Memorial Hermann Health System Invests in EnableComp, an Industry-Leading Specialty Revenue Cycle Management Solution

Houston-based Memorial Hermann Health System makes an unspecified investment in RCM vendor EnableComp.

Syntellis Performance Solutions to Acquire Stratasan, Expanding Healthcare Data Analytics Capabilities

Enterprise performance management software vendor Syntellis Performance Solutions acquires Stratasan, which specializes in healthcare market intelligence and analytics.

This cardiac care startup just landed $20M for virtual rehab services

Moving Analytics, a developer of virtual cardiac rehab programs, has raised $20 million in a Series A funding round that brings its total investments to $30 million.

Curbside Consult with Dr. Jayne 7/11/22

I missed the initial announcement last month, but the US Department of Health and Human Services has issued guidance on “How the HIPAA Rules Permit Health Plans and Covered Health Care Providers to Use Remote Communication Technologies for Audio-Only Telehealth,” which will apply even after the Office of Civil Rights “Notification of Enforcement Discretion for Telehealth” no longer applies. Audio-only telehealth is important for populations that don’t have adequate broadband access or who can’t access video visits due to disability, cell coverage, or other factors.

Seeing telehealth patients over the last four years, I found that nearly half of the patients I treated preferred audio-only visits, for a variety of reasons. There are some interesting details in the document on the use of traditional landline phone services as compared to electronic communication technologies such as internet-based phone services, cellular service, and Wi-Fi. The HIPAA Security Rule applies to the latter technologies, but not the POTS lines, although I’m not sure how many covered entities still use copper wire for their communications.

Most large healthcare organizations are trying to forecast what their use of telehealth services will look like in a post-pandemic world. In speaking with CMIO colleagues, it seems like their ideas on the topic run across a pretty wide spectrum. There are quite a few who feel that telehealth has provided substantial benefit for patients and providers and therefore plan to continue it. Those organizations are increasing telehealth budgets, working on staffing strategies, and more.

One health system that I follow is doubling down on virtual primary care, standing up virtual clinics and virtual patient panels. From a technology perspective, it feels like they’re just replicating their in-person workflows in the virtual world, complete with staff performing intakes and then referring patients to go visit the hospital lab and pharmacy at the end of the visit. They’re not yet approaching things like home phlebotomy or medication delivery. Other than not having to leave the house, the visits are pretty much business as usual, so they should seem familiar to the patients.

Another system I’ve consulted for in the past is retreating from telehealth somewhat. They’re adding additional capacity for nurse practitioners and physician assistants to offer same-day acute visits and are reducing the options for telehealth visits with primary care physicians so that the physicians can focus on patients who need to be seen in the office. That approach likely provides less convenience for patients who have grown accustomed to telehealth, and also potentially requires more real estate square footage since they’re going to have more providers and increased foot traffic in the offices. They feel that telehealth is impersonal and that their patients want a level of care that can only be given in person. As a patient, I’d argue that in-person care also brings a level of annoyance that many of us are trying to avoid.

We’ll have to see how it plays out and whether their capacity forecasts are accurate or whether they see patients defect to the health system across town since it’s still offering plenty of telehealth availability.

A recent survey from the Associated Press-NORC Center for Public Affairs Research and the SCAN foundation asked 1,000 US adults for their thoughts about what their lives will be like after the pandemic. While 48% said that telehealth was a “good thing” that should continue to be available, 52% responded that they’re not likely to use virtual care in a post-pandemic world. The breakdown of responses by age was interesting. For adults over 50, a mere 16% said they would continue telehealth visits. Looking at a younger crowd, 22% of adults under 50 said they would opt for virtual care. Not surprisingly, respondents with concerns about being infected with COVID-19 had a higher likelihood of wanting to continue with virtual healthcare. Most of the patients I see are in the under-50 age bracket, so I think it’s fairly likely they’ll want to continue with current telehealth options.

Looking more generally at the responses, only 12% of adults felt that their lives are the same today as they were before the pandemic, where 54% feel that life is somewhat the same and 34% feel their lives are not yet the same. Still, many adults in the US have resumed their pre-pandemic activities, including socializing with friends, dining out, visiting older relatives in person, travel, and worship. Only about half plan to use public transportation, which I find surprising given the rising cost of fuel (survey responses were gathered May 12-16, 2022).

Despite increasing COVID in my community (at least according to sewer shed data, since testing numbers are no longer reliable), the majority of people seem to be going about their business without masks, even though they’re recommended. I’ve had a combination of allergies and a cold for the last week, complete with eight negative COVID tests, and am convinced that since I haven’t had a cold in the past two years that I’ve forgotten how miserable it can be. Of course, it might just be undetectable COVID, but based on the negative tests and narrow symptom profile, I’d be surprised. No one I’ve been around has reported being sick either, so it’s a bit of a mystery if it’s something beyond just some wicked allergies. I engage in most of my pre-COVID activities, although most of them tended to be outside or with small groups of people and are fairly low risk.

I’ll be increasing my risk tolerance in coming weeks, as I have a couple of leisure trips coming up. I’ll be masking on the plane and in the airport and anywhere that seems like it doesn’t have great ventilation. One of the events I’m attending promises to be a reunion of sorts with lots of healthcare IT people I’ve worked with in the last decade, so I’m excited about that, as well as the ability to spend some quality time with one of my favorite healthcare personalities. I did some checking on the places I’m headed, and it looks like some of the entertainment venues still have mandatory masking. It will be interesting to be somewhere that’s a little stricter than home as far as preventive measures. I’ll be traveling with a stash of COVID test kits just in case, although I’ll be keeping my fingers crossed that I won’t need them. Hopefully during my travels, I won’t need any telehealth services, although I know where to find them if I need them.

Have you had to use telehealth while on vacation, and what was your experience? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Ashwini Zenooz, MD, CEO, Commure

Ashwini Zenooz, MD is president and CEO of Commure of San Francisco, CA.

Tell me about yourself and the company.

I’m a radiologist by background. I’ve been a practicing physician for most of my professional career. I made the switch a few years ago, officially, to government and policy. I worked on Capitol Hill and then moved on to continue my work in government at the Department of Veterans Affairs as an executive, then continued my work from there into tech.

Throughout that entire process, I’ve been an avid lover of what technology can bring to healthcare. From my first days as an attending or fellow, I remember all of the things that you could do to have more efficiencies in healthcare, and technology is at the core of it. I believe in the power of technology and I think we are at a great time at the intersection of tech and healthcare, so I’m excited to be here.

I joined this company because the single theme that I’ve been seeing throughout my career is that we have a lot of point solutions and they are continuing to increase. COVID just blew that out of the water. That’s great, because it brought a lot of access to patients and a lot of great solutions, but it became an even more disconnected system. The premise of this company is, how do we bring all of that health tech disconnect to make it work and empower the healthcare workforce? I love that idea, so I wanted to come here. 

We are building the first health tech operating system. Our goal is to bring in and unify multiple data sets and data services so that it is meaningful for the clinicians during those micro moments of care, help with the performance of the organization through these applications; innovate; and give the tools for the systems that are using us to have a platform for innovation that is unifying. I love that concept. We always talk about interoperability from a technology perspective, not from, how does it impact users and how do we make it work for them?  I love that we are actually bringing action to interoperability.

Who are the company’s competitors in data aggregation and API services?

The first thing I would say is that I don’t view data aggregators and API companies as competitors. In order for us to be a functional platform and operating system, it’s important that we bring multiple vendors and last-mile integration companies together. That’s important for us so we can have the data unified in a single place. That’s the first component.

When you reference data integration and APIs, some of that, especially the data integration, has different components. We don’t do the last mile of data integration. It’s once the data is coming together with all these different sources, how do we provide that unification and the unified view? For those, I would say that you could have platform companies as competitors that are out there, anything from a Microsoft or one of the other companies, but they are also partners for us because we build on top of them. Microsoft, Google, Amazon, et cetera.

I don’t think we are yet in a space where we have a competitor because we are the first health tech operating system that is actually bringing FHIR and non-FHIR data together. We are enabling different data structures and sources, and we have a solution where you can actually build on top. I don’t think that solution exists in the market as a whole. If you break down the individual components that we could have for each category, there’s a competitor.

I’m still not getting a picture of exactly what you sell and to whom. Can you give me an example?

We predominantly work with healthcare systems today. If you think of the healthcare system, they have on average somewhere between 10 to 16 electronic medical records or systems of record. They have radiology, laboratory, their main clinical EHR, and they have other data sources. They also work with multiple third-party point solution vendors. 

A lot of times, the healthcare system has to do the work of continually doing point-to-point integration with these third parties to make them effective with the vendors. By bringing in an operating system in the middle, they have found that they can scale those applications across the board by a single plugin. Once you integrate with Commure or you build a solution on Commure, the data automatically flows to anything that is connected with the Commure operating system.

Think of a switchboard, where multiple plugs are connected in. If you are connected into each other, then the data is set up in a way, structured in a way, where it has a common architecture, where you are able to communicate and have data. You have a clinician who has an EHR, they have patient data coming in from the glucose monitor, and you have third-party data that’s coming in. The system has built an algorithm, let’s say on top of Google Cloud for analytics. We can connect the dots and have a system of action. We can bring the algorithm to life and bring it to the forefront for that provider to make the decisions at that moment of care. We’re a transactional system. It’s not retroactive review of analytics. That’s who’s using us, and that’s one example for clinical.

Another example on the platform is using location services. Think about a nurse who is delivering care where there is violence in the workplace. All she has to do is push a button on the badge and we do the work on the back end, where we connect the dots between her to security and nearby employees so we can say, “Here’s the person that needs help.” We can engage. And all of this happens on the back end on the platform, whereas before, you would have to go to a nursing station, pick up the phone, call somebody, et cetera. We are able to connect the dots between clinical, operational, and financial through any app that is connected into the platform.

How do you bring EHR vendors to the table to make their data available?

For the operating system to be functional, you have to work with partners. EHRs are part of the partner ecosystem. It’s not going to work without working with the EHR partners. We have to be able to bring the data together and we have to make it useful. For us to bring the data sources together and for it to be meaningful, we have to work with the developer ecosystem that is building these incredible point solutions in the digital health market. We have to work with the existing laboratory and pathology systems that a health system might use. We have to work with the EHRs and the HIEs that are out there so that we can actually have this data come and for it to be meaningful.

With the PatientKeeper acquisition, we inherited two decades of great clinical experience and workflows that are adding to our vault of solutions. But the overall Commure operating system is going to require PatientKeeper solutions, other vendor solutions, and Epic and Cerner solutions to come together. To me, it’s all about figuring out how to collaborate and not remove these systems that are in existence and bring more cost to the healthcare system. I don’t think we should be kicking out the EHR because the services and functionality that Commure provides are additive and should be enhancing the EHR and enhancing the operational efficiency of the company.

There are a lot of things that the EHRs don’t do that a health system needs, and that a clinician needs. Those are the areas that we are providing a platform for innovation, where you can say, “You have this data. We have these templates for you.” You as a health system can work with your own team or you can work with third-party developers. You should be able to use a low-code or a no-code platform that we have to spin up the workflow that you need within a matter of weeks that it is integrated and connected to the EHR. You have an enhancement of your EHR. I don’t think we should be dislodging them. They do a great job at what they do, which is being the electronic recordkeeping system.

What will the industry look like in five years as startups build products that use existing health system data?

I think it’s fabulous. No one company can be the end-all, be-all in healthcare. If you have a monopoly in healthcare or you think that the EHR is going to be the source of all of your clinical workflows, all of your operational workflows, and all of your financial workflows, one, that’s going to be difficult.

Two, it’s not going to give the system any flexibility to think about new ways to innovate and work faster. COVID has opened up the ecosystem and has allowed for innovation. Health systems in particular realized that there is so much more that they need for a more efficient, better way to engage their patients and their providers. They saw that when we started shutting down and going to a virtual environment or hybrid environment with healthcare. That accelerated the innovation in healthcare, and I think that’s fabulous.

The only issue with that is that with so many point solutions, the healthcare system has to do the job of integrating all of those to make it meaningful for them to use it. We’re working with a healthcare system now that has over a 100 third-party vendors who provide point solutions, and some redundant solutions are being used across departments. That adds to the cost of the healthcare system, which goes against what we should be trying to do.

This is simplistic example, but if you think about the IOS or the Android ecosystem, they create a way for seamless consumer experience through this core data integration platform. Then they enable an easy app development platform and a robust suite of pre-built, ready-to-launch apps. Apple comes with Apple Maps, Apple Calendar, and Apple Mail, but that doesn’t mean that you can’t download one of the new innovative maps or scheduling apps or Waze or whatever that you want to use as a consumer. It is auto integrated. Just because you use Apple Calendar and Gmail for your email does not mean that those two don’t work together. 

I’d like to see that simplicity. That’s where we are going to head with a platform approach in healthcare, where you can have the best-of-breed solutions available to these health systems. But there’s not going to be the issue where interoperability and tech is a blocker. They will function together to reduce the friction for the user.

Has consolidation into bigger health systems enhanced demand for services like yours, as tech-savvy corporate offices connect systems that came with acquisitions?

The short answer is yes. It’s not just the EHRs when you see system consolidation. As we are moving into a new model of work, you’re going to have a lot of non-health system parties that work with the inpatient system. For example, you’re going to have multiple cardiology practices that refer patients and take care of patients inside of a central healthcare system. They are now part of the system. They don’t use the same EHR or billing or operational systems, but you need to give them the flexibility to work with each other. Solutions where you’re able to help with the network of innovation to bring all of this together so that the patient isn’t bothered when they’re going from their external cardiologist into an internal vendor — that’s where I see a lot of change.

It’s not just at the level of the EHR. It’s between the inpatient systems. How do you provide these seamless experiences for these providers, not just the patients, as they are caring for patients and they are traveling between these outpatient systems that are part of a network into the inpatient system? How do you provide the same flexibility as those providers are interfacing with the insurance companies? How do digital health companies refer in and out of a health system where they don’t belong?

That’s the new age of healthcare. It’s this hybrid model of care, the “click and mortar” system. That’s where the platform innovation is going, and we are going to see a lot more of it. It’s great for us because we truly believe that patients should have the flexibility and clinicians should have the data available when they need it without having friction from technology, which is what we enable.

What are the company’s priorities over the next few years?

Right now, we are really, really focused. You probably don’t see a lot of info from us because we are hyper-focused on working with some of our lighthouse customers. We have defined a few focused customers and we want to make sure that we are learning from them and partnering with them to come up with the best solutions. I don’t foresee us changing much from that course, because we are learning a lot and it’s helping us build our product roadmap and introduce new solutions to the market. I would say that we’re going to continue along that path.

We are seeing a lot of requests for payer-provider collaboration and how we can enable that, so we will think about how to extend our platform and the operating system to help connect the dots, as clinicians are working not only across other healthcare systems or across their networks, but also with the payers in the ecosystem.

I don’t think that there’s a silver bullet in healthcare, “one size fits all” solutions. We have to be open to the approach of collaborating and working together, including multiple EHRs working together and multiple competitive companies working together, to help provide the best care for patients and the best experience for providers.

Morning Headlines 7/11/22

Cardinal Health’s Outcomes acquires smart prescription platform ScalaMed

Cardinal Health acquires ScalaMed, whose app is used by patients to receive their electronic prescriptions on their phone, giving them the ability to price-shop and choose their pharmacy after the fact.

Astria Health and Cerner reach settlement in billing system case

Astria Health and Cerner settle their legal dispute in which the health system blamed its 2019 bankruptcy on problems with Cerner’s billing system, a claim Cerner disputed with the rebuttal that Astria poorly managed its merger with two other hospitals.

OhioHealth to eliminate 637 jobs in its biggest layoff ever

OhioHealth lays off 637 employees, 567 of whom are in IT, as part of the outsourcing of its IT work to Accenture and RCM to AGS Health.

Oracle Discussed Laying Off Thousands of Workers

Oracle has reportedly considered cost-cutting measures of up to $1 billion that could include thousands of layoffs within the next several weeks.

Monday Morning Update 7/11/22

Top News

An Oracle EVP says in a letter to two members of of VA’s Subcommittee on Technology Modernization that the VA’s Cerner system was “not operating as intended” at Mann-Grandstaff Medical Center, in which an “unknown queue” problem caused patient orders to be delayed or lost.

The company says Oracle’s expertise and technology will be used to “rethink approaches not possible before the acquisition.”

Cerner and the VA had agreed on how the queue would be used to detect incorrectly entered orders going back to January 2020, but the VA didn’t train its clinicians to monitor it.

The letter was signed by Oracle EVP and company lobbyist Ken Glueck.

This is good reporting from Orion Donovan-Smith of the Spokane Spokesman-Review.

Meanwhile, Oracle is reportedly considering cost reductions of up to $1 billion that would result in the layoff of thousands of employees as early as next month. Its recent $28 billion acquisition of Cerner added 28,000 employees to Oracle’s headcount of 143,000.

Reader Comments

From Promo Copy: “Re: remote work. Trading tomorrow’s job opportunities for today’s convenience.” I agree that you want to be a familiar company presence when career-advancing plum assignments, promotions, and cross-training opportunities are handed out. Folks who want those things – exceptions being those who mostly travel to customer sites, who aren’t looking to move up, or who work for a company whose executives are also working remotely – might want to watch how those opportunities are doled out based on where the recipient sits. Companies are fans of remote work when they can spend less for office space, pay non-metro salaries in some cases, and get longer workdays for free, but I would be slightly concerned that — other than the atypical use case of superstar Silicon Valley software engineers — executives might then extend the successful proof of concept to workers who are much further away and much cheaper. I also think that companies that skip the hybrid model and allow some but not all employees to work offsite permanently will either reel it back in or inadvertently create two classes of employees who benefit in different ways, which is perfectly fine as long as employees understand their career path options.

HIStalk Announcements and Requests

Poll respondents don’t see a lot of clinician time being wasted doing lower-level work, which is a better result than I expected.

New poll to your right or here, related to the above discussion: Where are the C-level executives of your employer routinely working, other than when traveling? It occurs to me that maybe most employees don’t even know where the suits sit.

Thanks to these companies that recently supported HIStalk. Click a logo for more information.

Webinars

July 12 (Tuesday) 1 ET. “Digital Data Stewardship for Trusted, High-Quality Data Exchange.” Sponsor: Clinical Architecture. Presenter: Carol Graham, MS, RN, product manager, Clinical Architecture. Organizations face challenges in ensuring that the patient data they received and send is consistent, accurate, and usable. Use cases include receiving multi-source data across health information networks with variation in formats and content; merging and de-duplicating provider, payer, and research data; uplifting legacy data for current use cases and formats; and normalizing and formatting data for public health surveillance, quality measure reporting, and providing directly to the patient. This webinar will cover Pivot, a comprehensive Digital Data Steward solution that orchestrates format harmonization, content (vocabulary) normalization, de-duplication, and data quality validation into a single solution.

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

Acquisitions, Funding, Business, and Stock

Cardinal Health acquires ScalaMed, whose app is used by patients to receive their electronic prescriptions on their phone, giving them the ability to price-shop and choose their pharmacy after the fact. I like this a lot since I’ve long maintained that e-prescribing forces patients to choose a pharmacy upfront without knowing cost or availability details, then wastes their time (and that of their prescriber) in trying to move the prescription to a different pharmacy.

Sales

• Canada’s Niagara Health chooses Sectra’s radiology, cardiology, and VNA systems.

People

Deana Rhoades, MBA (NTT Data) joins ZeOmega as VP of business development and channels.

Jill Jemison, MBA (University of Vermont) joins the University of North Carolina medical school as associate dean/CIO.

Ontario Clinical Imaging Network names Shafique Shamji (The Ottawa Hospital) as president and CEO.

Logan Health (MT) hires Steve Garske, PhD, MBA (Pipeline Health System) as CIO.

Announcements and Implementations

Astria Health and Cerner settle their legal dispute in which the health system blamed its 2019 bankruptcy on problems with Cerner’s billing system. Cerner disputed that claim, saying that Astria poorly managed its merger with two other hospitals.

A new KLAS report in PACS in Europe finds that Agfa, Philips, Sectra, and Visus have broad footprints and are growing, with Philips and Sectra having the largest number of high-volume customers.

Government and Politics

Public health experts say that the US is repeating its same COVID-19 mistakes with monkeypox, which should be easy to eliminate because it’s a known pathogen that spreads poorly and had tests and vaccines available before the outbreak began in May. Tests are hard to obtain, vaccines will be in short supply for months, surveillance and contact tracing are poor, and official case counts are are lower than actual. Doctors who see suspected cases must obtain approval from state epidemiologists to send patient samples to CDC, which then takes several days to run the tests and approve the diagnosis.

Other

State-run hospitals in Maharashtra, India report “chaos” as the state unexpectedly and permanently shuts down its Hospital Management and Information System in a dispute with the outsourced service provider. Officials say the contractor refused to pay penalties for poor system performance, so its contract was terminated, after which the vendor refused to provide copies of the hospital data. Those officials added that a new system is ready to install once upgrades are applied.

A Columbus TV station profiles an Epic ASAP analyst who is one of 637 employees OhioHealth is laying off as it outsources IT work to Accenture and RCM to AGS Health. Of the 637 eliminated jobs, 567 are in IT. OhioHealth says that eliminating jobs and hiring “technology and global talent pool external providers” will improve patient care.

A KHN report says that a shortage of mental health therapists is sending patients to online therapy companies, many of them backed by venture capital firms who advertise directly to consumers, whose questionable practices may include using texting with no guarantee of immediate response instead of real-time communication. One company pays therapists per word of text that they write or read. Those companies pay less and thus attract less-experienced providers who are not trained to deliver safe and effective care online. The founder of the Telebehavioral Health Institute questions whether parents should trust an online therapist to treat depression and anxiety in their children, concluding, “”What’s happening is a corporate takeover of behavioral healthcare by digital entrepreneurs.”

Consulting firm president Fred Goldstein tweeted the result of his hour-long wait for a virtual visit from Amwell. I’ve had similar experiences with ride-sharing services, where my assigned driver decided that my fare wasn’t worth their time and cancelled, but you would think telehealth providers would have a way to reassign the visit to another doctor. Interesting to me is that the doctor who cancelled is the chief product officer and medical director of Grapefruit Health, which offers telehealth services to schools. Still, I blame the company’s platform more than the doctor, who may have had a personal emergency that would have created the same result for an in-office visit. It happened to me once – I showed up for a scheduled doctor visit, appeased the clipboard gods with a solid 10 minutes of handwriting (this was my second visit to this single-doctor practice), waited for maybe 20 minutes past my scheduled time, then was called up by the customer-indifferent front desk person to be told that the doctor had the whole day off. I complained and was indignantly told that someone had mistyped my phone number and they couldn’t each me, which of course failed to explain why they checked me in and let me sit there. The doctor, who was much better at medicine than business, apologized afterward and suggested that I call after hours to avoid her incompetent employees

Sponsor Updates

• Symplr forms an executive customer council to drive its vision for strategic healthcare operations.
• Net Health adds Pressure Injury Deterioration Risk indicator into its Tissue Analytics AI-powered wound imaging and analysis solution, and a Missed Visit Prediction indicator to its Wound Care EHR.
• OneMedNet appoints Christoph Zindel, MD to its board.
• Arrive Health publishes a new customer success story featuring UCHealth, “Arrive Health Helps Doctors Cut Prescription Costs for Patients.”
• Spok announces that Asia Pacific value-added distributor InTechnology Distribution will offer Spok products and services.
• Talkdesk wins Cloud-Based CX Solution of the Year at the 2022 Customer Contact Week Excellence Awards.
• TigerConnect introduces draft mode for physician scheduling.
• West Monroe Innovation Fellow Doug Laney publishes a new book, “Data Juice,” about the 101 ways business leaders can monetize their data.
• Wolters Kluwer Health has expanded Ovid with SRI International’s BioCyc collection of organism-centric Pathway/Genome Databases and bioinformatics software tools.
• Zynx Health and the Hendrich Fall Program form a joint alliance that enables providers to access comprehensive and holistic fall prevention care guidance.

Blog Posts

• Post COVID-19: 4 Healthcare Consumer Behavior Changes from the Pandemic (PatientBond)
• Nurses of Note Awards 2022: The Nurse Navigator and Staff Educator (PerfectServe)
• What’s in a Title? How the Role of the Credentialing Professional is Changing (Symplr)
• Five Trends of Change in the Life Sciences Industry (Premier)
• How to select the most effective call center software (5 tips and best practices) (Talkdesk)
• Keeping Pace with Patient Expectations in 2022 (WebPT)
• Allowing Patients to Utilize Their Own Devices Encourages Patient Engagement (VitalTech)
• The Year of Healthcare Interoperability (Zen Healthcare IT)

Contacts

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