Monday Morning Update 10/10/22

Top News

Virginia Mason Franciscan Health (WA), part of the CommonSpirit Health system, updates patients on the ongoing, unspecified IT incident that last week forced many CommonSpirit facilities to revert to downtime procedures, divert ambulances, and reschedule appointments.

CommonSpirit has yet to issue a statement.

Patients, meanwhile, are growing frustrated by the lack of digital access, which has turned online appointment scheduling and record retrieval into processes more laborious than usual. Prescription refills have also been impacted.

HIStalk Announcements and Requests

The majority of poll respondents are in favor of the HHS decision to hold firm on the October 6 deadline for information sharing.

New poll to your right or here: Which of the following items did you earn after age 35 that has been most valuable in your career? If you’ve done something on the list that turned out to be a great career booster in your 30s or after, others would no doubt be interested. I’m sure I didn’t think of every possible item, so add a poll comment if you earned some other credential that paid off big time.

An Olive rep clarified some points from Thursday’s news post regarding the company’s decision to divest its population health and 340b products: Those offerings make up less than 3% of the company’s revenue and no longer align with Olive’s product strategy. Two of its customers gave notice in August and September, in contrast to the number in the original article.

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

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

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

Sales

• The VA selects Coforma to assist it in developing clinical decision support apps and EHR integrations.
• A Northeastern health system selects VisiQuate’s denials management, revenue management, and reserve analytics.

Announcements and Implementations

Image-sharing vendor Send Mammogram implements ClearData’s CyberHealth cybersecurity technology.

Box Butte General Hospital (NE) postpones its roll out of Meditech Expanse as it takes into account lessons learned from a mock live event held in late September.

EClinicalWorks announces the addition of sign, patient survey, and chatbot capabilities to its family Healow patient engagement apps at its annual user conference, where it also launched the latest version of its EHR. CFO Mark Speyer noted that the company has increased its staff count by 10% in 2022, and will continue to hire in the next year.

Government and Politics

Oracle Cerner engineers resolve an application package coding issue that caused the VA’s EHR pharmacy module to go down for 11 hours last week. In a separate incident, certain patients were unable to access the Defense Enrollment Eligibility Reporting System, a database of US military members, family members, veterans, and others eligible for military benefits. That issue resolved without technical intervention.

Other

The Nebraska Hospital Association and the University of Nebraska Medical Center prepare to launch an initiative that will give researchers access to the hospital’s de-identified claims data. The association hopes to partner with additional hospitals willing to give researchers access to similar data sets.

Intermountain Healthcare (UT) begins offering delivery of specialty pharmaceuticals and certain over-the-counter medications by drone to eligible patients in the Salt Lake Valley area. The health system, which first announced its drone delivery plans in 2018, has partnered with San Francisco-based company Zipline to offer the service.

Sponsor Updates

• Clearwater sponsors the Nashville Health Care Council Golf Tournament.
• Meditech and Forward Advantage develop the PxMobile healthcare system-branded app.
• Methodist Health System extends its 25-year relationship with Oracle Cerner with a 10-year contract extension.
• Optimum Healthcare IT names Shane Kuppler (Health Care District of Palm Beach County) Epic revenue cycle analyst.
• Relatient releases a new episode of Dash Talk Podcast, “How Better Access Gives OrthoSC a ‘Leg Up’ on Care Delivery.”
• Talkdesk receives two Frost & Sullivan 2022 Customer Value Leadership Awards for vertical market excellence.
• Tegria will present at the HFMA Region 2 Annual Fall Institute October 13 in Verona, NY.
• Volpara Health receives a 2022 Good Design Award for Volpara Analytics in the digital design category.

Blog Posts

• Key Takeaways: Evolution of Healthcare Systems (Pivot Point Consulting)
• Nurses of Note Awards 2022: The Clinical Practice Specialist (PerfectServe)
• Top 3 Takeaways from the AHIP Consumer Experience & Digital Health Forum (Redox)
• In-house vs. Outsourcing: The Benefits of a Chart Abstraction Service (ReMedi Health Solutions)
• What is call center routing and how does it improve customer experience? (Talkdesk)

Contacts

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

Morning Headlines 10/7/22

Call it data liberation day: Patients can now access all their health records digitally 

Federal rules take effect that will enable patients to obtain all of their medical records in digital format upon request.

CMS Asks for Public Input on Establishing First, National Directory of Health Care Providers and Services

CMS solicits feedback on the idea of developing a national directory of healthcare providers and services.

Alleva Raises $12 Million Series A Led By Ankona Capital

Behavioral health IT vendor Alleva raises $12 million in a Series A funding round.

Nordic Consulting Acquires Healthcare Consulting Company Hygeian

Nordic Consulting acquires Hygeian, a healthcare consulting and staffing firm that serves customers in the UK and Middle East.

News 10/7/22

Top News

Federal rules take effect today that – in theory – will enable patients to obtain all of their medical records in digital format upon request.

A number of provider organizations attempted to get the October 6 deadline extended so that they could have more time to prepare for patient requests, and to better understand the penalties of failing to comply.

CMS has not yet made clear the ways in which providers and health IT vendors will be held accountable for failing to adapt to this new era of liberated patient data.

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

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

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

Acquisitions, Funding, Business, and Stock

Patient acquisition, engagement, and remote patient monitoring company PatientPoint acquires eye care-focused competitor Rendia for an undisclosed sum. Rendia CEO Smitha Gopal will also take on the new role of PatientPoint EVP of subscription and procedure-based specialties.

Private equity firm TPG acquires Change Healthcare’s ClaimsXten claims-editing business for $2.2 billion as part of the terms of UnitedHealth’s acquisition of Change.

Health information management vendor ScanSTAT Technologies reportedly puts itself up for sale. It acquired competitor Resolve ROI in August.

Nordic Consulting acquires Hygeian, a healthcare consulting and staffing firm that serves customers in the UK and Middle East.

Healthcare automation company Olive will sell its population health management and 340b program assets to Rotera. The move is in keeping with its decision earlier this year to streamline its offerings. Olive launched Rotera, which also offers healthcare automation software, out of its venture studio in 2021.

Sales

• Acute Behavioral Health (TN) will use Owl’s measurement-based care software to help its staff track patient progress and quantify treatment effectiveness.
• Virtual primary care vendor CirrusMD selects NeuroFlow’s behavioral health-focused clinical decision support, intervention services, and patient engagement capabilities.

People

Chesapeake Regional Information System for Our Patients promotes Craig Behm to president and CEO of CRISP and CRISP Shared Services.

Announcements and Implementations

The SSI Group leverages Myndshft’s automated prior authorization software to power its new PA technology.

CommuniCare implements EClinicalWorks across its 22 sites in Texas.

Google Cloud announces GA of its new AI-enabled Medical Imaging Suite.

Birmingham and Solihull Integrated Care System, Coventry and Warwickshire ICS, and Herefordshire and Worcestershire ICS implement InterSystems HealthShare.

Littleton Regional Healthcare (NH) goes live on Oracle Cerner’s Community Works EHR.

WVU Medicine adds Findhelp’s social and human services search tool to its Epic patient portal.

Nym makes its medical coding engine available to radiology departments.

LexisNexis Risk Solutions launches the Gravitas Network, a clinical research data hub incorporating de-identified data sets from PointClickCare, Ovation, Solis Mammography, health systems collective Truveta, and the Institute for Health Metrics.

Software development company Academy Medtech Ventures implements Clearwater’s ClearAdvantage managed cybersecurity and compliance services.

Government and Politics

CMS solicits feedback on the idea of developing a national directory of healthcare providers and services.

Privacy and Security

CommonSpirit Health facilities in Iowa, Nebraska, Tennessee, Virginia, and Washington continue to deal with the effects of Monday’s unspecified IT incident, which impacted several enterprise systems, including its EHR. Local news reports say that many CommonSpirit sites in those states have reverted to paper-based procedures, diverted ambulances, and postponed appointments.

Sponsor Updates

• CereCore staff volunteer with the Utah Food Bank and Nashville-based Pencil.
• CHIME releases a new Leader to Leader Podcast featuring Clearsense President Kevin Field.
• EVisit ranks among the top three telemedicine vendors for customer satisfaction, according to a JD Power study.
• Net Health integrates Alinea’s workflow automation and patient and family engagement capabilities with its Therapy for Senior Living software.
• Experity encourages urgent care leaders to submit nominations for its annual Industry Limelight Awards through November 14.
• LexisNexis Risk Solutions publishes a new customer success story, “VGM & Associates and Its Members Increase Market Share and Improve Sales Targeting.”
• Lyniate publishes a new case study, “Greater Bristol Connecting Care underpins Exemplar status with Lyniate EMPI by NextGate for identity data management.”
• Medicomp Systems releases a new Tell Me Where It Hurts Podcast featuring CHIME VP of Public Policy Mari Savickis.
• Meditech adds sepsis detection tools to its Sepsis Management Toolkit.

Blog Posts

• Four Easy Ways to Protect Yourself Online (Fortified Health Security)
• Bring Your Own Device: The Evolution of Patient Engagement (Get Well)
• How Can Supply Chain Do More with Less in the Face of Unprecedented Turnover? (GHX)
• Hire a Consultant for IT Changes and Keep Your Hospital Running Smoothly (HealthTech Resources)
• Souped-Up Search Results: How They Save Clinicians Time (Healthwise)
• Path to Patient Empowerment: Why Healthcare Must Break Data Silos (InterSystems)
• A Q&A with IMO: NextGen and EHR workflows (Intelligent Medical Objects)
• Digital Self-Service: A Must Have for Consumers (Kyruus)
• Healthcare Cybersecurity Awareness Resources (LexisNexis Risk Solutions)
• 3 Major Healthcare IT Security Topics for 2023 (Medhost)
• A new era of health IT transformation revealed at Meditech Live (Meditech)
• Productivity: Why This KPI Matters for Skilled Nursing Rehab Therapy Teams (Net Health)
• Ambient clinical intelligence (ACI) – what it is and why you need it (Nuance)
• Telehealth and LTPAC Part 1: Making Virtual Care a Reality Beyond COVID-19 (Netsmart)
• De-implementation: “Just say no” isn’t enough (Nordic)
• Three potential patient safety risks that can be addressed through technology (Wolters Kluwer Health)

Contacts

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

EPtalk by Dr. Jayne 10/6/22

CMS has released a Request for Information on the idea of a national directory of health care providers and services. The announcement notes that such a compilation might “help facilitate care coordination, health information exchange, and data reporting efforts.” They note, “We envision that an NDH [National Directory of Healthcare Providers and Services] could serve as a centralized data hub for providers’ directory and digital contact information, which would contain accurate, up-to-date, and validated data in a publicly accessible index.” On the surface, this seems like a good idea, until one realizes that there have already been efforts to attempt to create a master database.

My current CMS provider records contain a practice address where I haven’t worked since 2011 despite multiple attempts to update it, so I’m not optimistic about efforts to maintain yet another database. It would also be difficult to account for the information for physicians and other providers who work part time at different institutions, which can be common for certain specialties or classifications of physicians. For example, faculty physicians at my academic medical center might have separate practices (complete with separate billing and communications information) at the faculty practice, the residency practice, the hospital service, and the local Veteran’s Affairs clinic. Similarly, many physicians “moonlight” or pick up extra shifts via urgent care or telehealth companies, so that will add to the confusion. The public comment period ends on December 6, so be sure to submit your thoughts.

The concept of patients calling physicians by their first names is always a hot topic in the virtual physician lounge so I was glad to see this research letter published this week in JAMA Network Open. In the introduction, the authors note the sentiments shared by many physicians, that using the title “doctor” helps in “acknowledging the physician-patient relationship, signifying respect for physicians, and following established social norms.” They mention the results of two previous related studies – one that found that almost three out of four physicians were called by their first name, with 61% finding it annoying, and another that found that having “DOCTOR” boldly indicated on ID badges was associated with fewer episodes of misidentification among female physicians and physicians in underrepresented groups. With that background, the authors set about determining the factors associated with use of the physician’s first name in patient portal messages.

The authors performed a retrospective review of patient messages in the Mayo Clinic EHR from October 1, 2018 to September 30, 2021. Natural language processing was used to identify the greeting and/or closing salutation and those phrases were classified according to formality. Patient demographics (age, gender) as well as physician demographics (age, gender, degree, training level, and specialty) were all identified. The authors found that female physicians were twice as likely to be called by their first names after controlling for other factors. Physicians with a DO degree were also more likely to be called by their first name, as were primary care physicians. Interestingly, female patients were less likely to use their physician’s first name. There was no difference based on patient or physician age or physician training level.

The study has a few limitations noted by the authors, including inability to control for physicians who may prefer to be addressed by their first names or for cultural/racial/ethnic nuances in greetings. The dataset was also from a single health system, so might not be applicable to other organizations. It would be interesting to see how these factors play out in different regions across the United States, since there are definitely nuances in how people are addressed regardless of whether they’re physicians or not. I’ve been called everything from “ma’am” to “y’all” to “sweetie” to “hey yo” to things that are not fit to print while practicing my physician trade, so I’m guessing there might be variation on professional titles as well. I’m currently following a thread in a CMIO group about patient portal messages and which state might best exemplify “upper Midwest nice,” so there’s definitely a physician perception of regional variability.

The authors note that “whether being informally addressed by other medical professionals or patients, untitling (not using a person’s proper title) may have a negative impact on physicians, demonstrate lack of respect, and can lead to reduction in formality of the physician-patient relationship or workplace.” They go on to state that organizations need to focus on a supportive culture and that guidelines, practice changes, or patient education may be needed. The idea of lack of respect is a common sentiment around the virtual water cooler, but times are changing and, at least in the US, social norms feel far more casual than they did a decade ago. I’ll be interested to see what kinds of comments might be added to the article since it’s so new. Responses have been mixed on several platforms that have posted articles referencing the study.

Regardless of title, role, or status, it’s always a good idea to ask people what they prefer to be called, and to discuss if you feel the need to call someone something different than what they request. I’ve worked with seasoned nurses who actively struggle with the idea of calling physicians by their first names even when asked to do so, and in those cases I’m not about to force the issue. Similarly, I wouldn’t dream of calling an adult patient by their first name without their permission, and am happy to note individual preferences on the patient chart. Half the time I refer to pediatric patients by formal titles just to make them laugh since they’ve likely never been called “young Master Johnson” or “my dear Miss Jones,” and it’s fun to watch their faces. I rotated in the UK many years ago and did enjoy the certain level of formality at my practice site where everyone referred to each other as “Nurse Thompson” and “Dr. Jones” and “Trainee Jayne,” but I don’t know if that style has remained.

Does your organization have a policy on title use, or is it anything goes? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/6/22

PatientPoint Acquires Rendia to Accelerate Expansion into Ophthalmology Specialty

Patient engagement vendor PatientPoint acquires eye care-focused competitor Rendia for an undisclosed sum.

Drummond Group Introduces Pediatric Health IT Certification Program

Drummond Group, the certifying body for ONC’s Health IT Certification Program, launches a Pediatric Health IT Certification program to help health IT vendors advance pediatric EHR capabilities.

TPG seals $2.2B deal for ClaimsXten

Private equity firm TPG acquires Change Healthcare’s ClaimsXten business for $2.2 billion as part of the terms of UnitedHealth’s acquisition of Change.

Readers Write: Taking Clinical Natural Language Processing Mainstream for Effective Care Management

Taking Clinical Natural Language Processing Mainstream for Effective Care Management
By Kevin Agatstein

Kevin Agatstein is CEO of Kaid Health of Boston.

Across healthcare, clinical natural language processing continues to play an ever more influential role. Kreimeyer et al.’s “Natural language processing systems for capturing and standardizing unstructured clinical information” identified over 70 different CNLP systems in the literature, spanning multiple clinical domains. Unfortunately, few of these directly address the applicability of CNLP to care management. This lack of CNLP supporting care managers will and should change. Making this reality will require adapting the technology to the real-world needs of care management programs and the front-line clinicians who staff them. 

To fuel effective care management, actionable data is required across the entire workflow. Examples of actionable data include information that: 

• Identifies which patients require help.
• Stratifies patients for intervention.
• Summarizes the patient for the care manager.
• Determines the specific actions the patient needs.
• Uncovers the barriers to effective care.
• Measures intervention outcomes.

Claims data, lab data, health risk assessments, and motivational interviewing all meaningfully contribute to the above. While all of these are necessary, alas, they are not sufficient. For the care manager to meaningfully coordinate patient care, to accomplish the six steps listed above, they must have access to actual clinical data. They need the medical record. More precisely, they needs the nuggets of actionable insights buried in the massive EHR data set. Finally, they need it to be quickly digestible. Thus, CNLP can not only help, it is all but required.

This actionable data is almost all in the EHR; however, it can be hard to find. A patient’s medical record is often hundreds of pages of text, alongside hundreds of discrete data points (labs, medications, allergies, etc.) Within this morass of usually loosely organized data is the patient’s health history. While claims and labs can give some sense of the patient’s clinical experience, the chart has the diagnosed but not coded conditions, the written but not filled prescriptions, and more. It also has a plethora of exam findings, laboratory reports, radiologic data, and pathology findings that never get put into “structured” EHR fields.

Kharrazi et al., in “The Value of Unstructured Electronic Health Record Data in Geriatric Syndrome Case Identification,” found that the EHR text resulted in finding 1.5 times more patients with dementia than just reviewing the structured EHR data. That same ratio was 1.7 with decubitus ulcers, 2.9 for weight loss, and 3.2 for a history of falling.

Beyond traditional clinical data, the chart often contains insights into the patient’s family health history. It also has data on psychosocial barriers to care, limitations on activities of daily living, and other elements impacting the patient’s care journey. Just as crucial for care managers, the chart typically has data on the patient’s social determinants of health. While SDOH are almost never coded in claims, (and yes, there are ICD-10 SDOH codes), they are noted in charts. AI-powered healthcare data analysis and provider engagement platforms have found hundreds of SDOH in primary care, specialists, ED, and behavioral health charts. Kharrazi found similar results. For example, they found that it is 456 times more likely to find a patient with a “lack of social support” in the free text of the medical note than in the structured data.

For a care manager to do their job well, this data cannot be ignored.

More than just summarizing the patient’s health, the medical record can help translate the EHR text into a structured, actionable, trackable ambulatory care plan by summarizing the physician’s treatment plan noted for each encounter. Specifically, NLP can create a patient to-do list such as follow-up visits, getting testing or labs, addressing unhealthy behaviors, and more. These identified tasks can become the basis of a care management care plan or added to existing plans. As new data enters the chart, either as structured information or new medical notes, the to-do list can be updated. Tasks can be marked as completed, new tasks added, existing tasks amended, and more.

It’s important to remember that NLP algorithms do not digest a medical note the way a human does. Rather, they predict how a trained human would interpret the presented text. This is much more than finding key words. CNLP solutions also need to account for:

• Negation (“does not have cancer”).
• Family history (“the patient’s mother had an MI before age 55”).
• Uncertainty, (e.g., “initial lab findings mean early-stage chronic kidney disease possible, but additional testing is needed”).
• And more.

Making such determinations isn’t perfect, but making useful interpretations of clinical text has been proven possible. Moreover, CNLP does not fatigue as humans do. For example, Suh, et. al. found in “Identification of Preanesthetic History Elements by a Natural Language Processing Engine” that CNLP frequently identified salient clinical facts that a physician reviewer missed. 

Now, new data standards, notably FHIR, and regulatory mandates to share data combine to markedly simplify a CNLP deployment process. This, plus cloud and other emerging data exchange standards, mean CNLP go-lives can be measured in days, not months. By working with partners with rigid technological and workflow controls, extensive security training, and a culture of data security, the data can be processed safely as well.

For a real-world deployment, a care management CNLP solution should be intuitive to clinicians. It should be focused on the needs of care managers to anticipate the workflow. Care managers today deal with several different medical record and care management documentation systems. Effectively managing these variations, and the vagaries of existing workflows, comes only with experience. Most importantly, CNLP needs to add value for the user practically out of the box. They can, and they will.

Readers Write: Diagnostically Connected Data – The Key to EHR Clinical Usability

Diagnostically Connected Data: The Key to EHR Clinical Usability
By Dave Lareau

Dave Lareau is CEO of Medicomp Systems of Chantilly, VA.

Clinicians are among the most highly trained knowledge workers in any industry, yet the systems they use to care for patients often actually hinder their ability to deliver care. We hear anecdotes from patients about clinicians spending inordinate amounts of time trying to find information in their EHRs – only to often give up rather than search through other sections of the chart to find a lab result, view past encounter notes, or try to correlate medications with problems or the course of a condition.

EHRs require users to spend too much time searching for clinically relevant information for the patient they are treating and, once that information is located, to go through a series of disconnected processes to complete their work.

This situation will only get worse once the floodgates of healthcare data interoperability are opened. Then, it will be even more challenging for clinical users to find what they need.

Consider the bright side of this data-driven conundrum: The effects of the 21^st Century Cures Act and TEFCA will make it easier for HIT systems to send and receive information. Plus, emerging terminology standards and the use of common codes such as ICD-10, SNOMED, LOINC, RxNorm, CPT, DSM5, CTCAE, UNII, CVX, and others will provide a basis for what is often called “semantic interoperability.” And today, the performance of natural language processing is getting more consistent and reliable, providing a means to convert free-text notes that use those same terminologies and codes.

So, does that mean that more coded data is a good thing?

Not necessarily – that is, unless clinicians can readily locate the information they need to assess, evaluate, treat, and manage a given patient and their clinical problems. With the widespread adoption of risk-based reimbursement through Medicare Advantage and similar programs sharpening the focus on chronic condition management, it will be increasingly crucial for clinicians to see a diagnostically focused view for each patient along with their medical problems. They need instant access to this view, without searching through disparate sections of the EHR.

Semantic interoperability facilitated by standard terminologies and code sets is a great start – and is necessary for sharing clinical information between systems. It will also drive better analytics and population health insights. But it will not make it easier for clinicians to find the data they need for the patient at the point of care (whether that patient is in-office or on a screen.)

Most existing EHRs, and the terminologies and codes for semantic interoperability, are structured in distinct “domains.” In an EHR, this typically shows up as separate sections or tabs – problem list, medication list, laboratory orders and results, procedures, encounter notes, discharge summaries, etc. Problems, meanwhile, have ICD-10 and SNOMED codes, labs have CPT and LOINC codes, medications have RxNorm or NDC codes, and other domains use other code sets. These codes were designed for their specific domain. They were not designed to work together for the clinical user.

The key to usability is to link these to the problem list, so that the user can click on a problem and immediately view the related medications, labs, procedures, therapies, co-morbidities, and findings from encounter notes that all are related to the problem. This diagnostically filtered presentation could be viewed longitudinally and supported by millions of mappings from standard terminologies and code sets.

Such a unique diagnostic relevancy engine would provide both the semantic – and diagnostic – interoperability that enables clinicians to not only see what they need at the point of care, but also to harness the flood of interoperability-driven data that will soon complicate their work.

Morning Headlines 10/5/22

Paper charts, canceled appointments at VMFH clinics, hospitals as network outage drags on

Computer networks remain offline at numerous facilities within the multi-state CommonSpirit Health system due to an unspecified IT security incident that occurred Monday.

Epic overhauls popular sepsis algorithm criticized for faulty alarms

STAT reports that Epic now recommends that its sepsis prediction model be trained on a hospital’s own data before clinical use, and that the company has changed its definition of sepsis onset to a more commonly accepted standard.

Smile CDR Rebrands to Smile Digital Health

Clinical data repository vendor Smile CDR rebrands to Smile Digital Health to reflect its expanded focus on health data and integration.

The Way Forward for Mental Healthcare: A Message from Dr. David Mou, CEO, Cerebral

Cerebral CEO David Mou, MD vows to enhance the online mental healthcare company’s clinical safeguards and patient identification verification protocols and software, among other changes, in response to scrutiny around its prescribing, marketing, and patient identity verification practices.

News 10/5/22

Top News

UnitedHealth finalizes its $7.8 billion acquisition of Change Healthcare, which it has merged with its Optum business. Change Healthcare has requested that Nasdaq de-list its stock from the exchange.

Reader Comments

From Apoagathos: “Re: CHI Catholic Health Initiatives. Looks like they were the victim of a ransomware attack yesterday.” CommonSpirit Health, CHI’s parent company, experienced an IT security incident Monday that impacted some of CHI’s facilities. CHI took some of its systems offline, including Epic.

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

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

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

Acquisitions, Funding, Business, and Stock

CTG acquires Eleviant Tech, a digital transformation company specializing in mobile, cloud, robotic process automation, and AI across multiple verticals including healthcare.

People

ChartSpan names Nic Erickson (Anthem) VP of patient enrollment and clinical operations.

Appalachian Regional Healthcare (KY) promotes VP of IT and CTO Mike Roberts to the additional role of CISO.

Jeff Silverman (Qualifacts) joins AccessOne as its first chief revenue officer.

Announcements and Implementations

Harnett Health (NC) switches from Meditech to Epic as part of its affiliation with Cape Fear Valley Health.

Government and Politics

ONC launches a dedicated information blocking webpage ahead of the October 6 information-sharing compliance deadline. It will host virtual office hours on October 6 and 27 to help healthcare stakeholders better understand information sharing under ONC’s information-blocking regulations. 

Other

Five months into the role, Cerebral CEO David Mou, MD shares several things the online mental healthcare company is doing in light of federal and media scrutiny around its prescribing, marketing, and patient identity verification practices:

• Expanding internal infrastructure and safeguards to prioritize the most vulnerable patients, especially those at risk for suicide.
• Improving patient ID verification protocols and software to ensure information is accurate and that treatment isn’t offered to minors.
• Reallocating resources from marketing to clinical quality efforts.
• Establishing a Quality Commission of outside experts to conduct performance reviews.

STAT reports that Epic now recommends that its sepsis prediction model be trained on a hospital’s own data before clinical use, and that the company has changed its definition of sepsis onset to a more commonly accepted standard. Epic’s model came under scrutiny earlier this year when a study in JAMA Internal Medicine found that it did not retroactively identify two-thirds of sepsis patients.

Sponsor Updates

• The Ascom US team participates in the Great Cycle Challenge to help beat kids’ cancer.
• Azara Healthcare integrates FindHelp’s social services referral and reporting tool with its Azara DRVS and Care Connect solutions.
• CHIME releases a new Leader2Leader Podcast featuring Oracle Cerner Chief Health Officer Nasim Afsar, MD “Advancing Health Equity.”
• Clinical Architecture EVP Carol Macumber receives the HL7’s 2022 W. Edward Hammond, PhD, Volunteer of the Year Award.
• Wolters Kluwer Health updates its Ovid medical research platform with two new, curated research collections – the Public Health Advantage collection and the Evidence-Based Health collection.
• Baker Tilly publishes its “Healthcare M&A Update H1 2022.”
• Southeast Kansas Mental Health Center upgrades its adoption of Netsmart’s CareFabric platform in support of it becoming a Certified Community Behavioral Health Clinic.

Blog Posts

• AHUG 2022: Impressions of User Group Meetings (Agfa HealthCare)
• Determining the MS-DRG – Clinical Documentation Improvement (AGS Health)
• Build vs. buy and the capabilities that matter in healthcare IT (Arcadia)
• Hospital-at-home as a care delivery model (Baker Tilly)
• A 988 IT Infrastructure Conversation with Bamboo Health’s Carol Tsang (Bamboo Health)
• Physician opinion: Preparing for the changing role of the practicing physician (Bravado Health)
• By Initiating Pas, Providers Can Give Pharmacists Time with Patients (CoverMyMeds)
• Fear, Uncertainty, and Doubt: The Promise of Cloud Computing in Healthcare (CTG)
• Data Standardization and APIs Can Help Pave the Way Toward Data-Driven Healthcare (Diameter Health)
• The Importance of Data Integration is Front-Page News (Dimensional Insight)
• 6 Tips for Becoming a Great Mentor (Divurgent)
• Back to School – for Your Practice, Too! (EClinicalWorks)
• Leader to Leader: A Data Revolution in a Consumer-First World (Clearsense)
• The Exponential Savings Potential for ACO Participants (ChartSpan)

Contacts

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

Morning Headlines 10/4/22

CTG Acquires Eleviant Tech to Accelerate Digital Transformation Strategy and Portfolio Innovation

CTG acquires Eleviant Tech, a digital transformation company specializing in mobile, cloud, robotic process automation, and AI across multiple verticals including healthcare.

Optum and Change Healthcare Complete Combination

UnitedHealth finalizes its $8 billion acquisition of Change Healthcare, which it will merge with its Optum business.

EHNAC and CARIN Alliance Announce New CARIN Code of Conduct Accreditation Program

The Electronic Healthcare Network Accreditation Commission and the CARIN Alliance, a collaborative focused on consumer-directed health data exchange, launch an accreditation program to bring the CARIN Code of Conduct and EHNAC’s criteria review process to healthcare stakeholders.

Curbside Consult with Dr. Jayne 10/3/22

For those organizations participating in the Medicare Promoting Interoperability Program, Monday, October 3 marks the last day to begin your 90-day reporting period. Eligible hospitals and Critical Access Hospitals that don’t successfully attest will be hit with a “downward Medicare payment adjustment,” also known as a penalty. Participants must also use Certified EHR Technology, report on the safe use of opioid medications, complete a Security Risk Analysis, and document a self-assessment using the SAFER Guides. Hospitals spend a tremendous amount of resources trying to make sure they hit all the requirements, so for those of you immersed in this work – may the odds be ever in your favor.

A friend of mine sent over this job posting from Amazon. They asked my opinion about the posting itself and if I could read between the lines to figure out what the job is really about. It reads to me more like a business development or sales role, specifically targeting telehealth, imaging, and analytics. In the job posting, Amazon has an entire paragraph about its inclusive culture and specific focus on race, ethnicity, and gender diversity. However, they missed the mark on actual physician inclusivity, since the preferred qualification is MD – I suppose DO and internationally-trained physicians need not apply.

News of the Weird: We see writeups of healthcare fraud all the time, but it’s been a while since I’ve seen one that is tied to a sex worker scheme. The Department of Justice announced that nine defendants in California have been hit with criminal charges related to sex services that were billed to their labor union’s health insurance plan. There are more than $2.1 million in claims at stake. Seven of the defendants are dockworkers at the Port of Long Beach.

The 46-year-old ringleader was charged with one count each of conspiracy to commit healthcare fraud and aggravated identity theft. She owned three clinics that provided chiropractic treatments, acupuncture, and sexual services. Taking advantage of insurance plan policies that allowed chiropractic services without a deductible or out-of-pocket payments from patients, she hired women, including those from strip clubs, to perform sexual services. Claims were filed for chiropractic and physical therapy sessions that never occurred. Some claims were filed under the names of spouses and children, with kickbacks being paid to plan members in exchange for the false claims.

It’s not just COVID that has the attention of physicians: Norovirus causes a wicked gastroenteritis, and is feared by schools, day care providers, and cruise lines alike. Although cases declined in April 2020 due to changes in behavior due to the COVID pandemic, cases started increasing rapidly in January 2022. The number of outbreaks in the 2021-2022 surveillance year was triple the previous year. It’s simple advice – wash those hands, folks, and stay home if you have diarrhea.

I’ve written before about my sometimes love-hate relationship with wearables. Although I like my Garmin wristwatch (which also does passive activity tracking such as steps or sleep alongside active GPS activity-logging), it’s been temperamental of late. Sometimes I’ll attempt to synchronize it with my PC, and it randomly fails to import several days of step or sleep data, where other times it functions just fine. I did a lot of troubleshooting with Garmin this week and didn’t reach a satisfactory outcome, although they did offer a 20% discount on a new watch in the same line since my model is no longer made. Unfortunately, the units in the same line have more bells and whistles than I need, where other lines that are a better fit are excluded from the discount.

The experience has me looking for alternatives from other vendors, but I’m not sold on anything just yet. I was interested to see this opinion piece this week though, which talks about the potential liability issues for “prediagnostic” wearables including some smart watches. It notes that many of these technologies are not regulated as medical devices and that although patients may use them to assess their health, there are legal gray areas where liability is concerned. From the physician standpoint, it’s unclear what happens when particular product is recommended, and it turns out not to be accurate. The article goes into gory detail about the various types of liability and differing jurisdictions for claims, if readers are interested. One proposed solution would be for states to pass laws that specify that physicians receiving this “prediagnostic” data should manage it like any other patient self-reported information. This will definitely be an interesting area to watch in the coming years.

Over the last couple of years, we’ve all encountered changes to the ways we’re used to working. For me, going from having quite a bit of travel to having none at all was a major transition. I’m definitely back to traveling and have experienced two vendor conferences, a couple of company meetings, and some personal travel in the last six months. Other than HIMSS in the spring, I haven’t attended any general industry conferences, but that’s about to change since CHIME and HLTH are both on my docket for the coming months. I haven’t been to either of them previously so am looking for advice or recommendations on how to best navigate them. It looks like CHIME has added a clinical informatics pre-session, so I’ll have to figure out if I can squeeze that onto my dance card.

I didn’t make it to my specialty organization’s annual meeting due to conflicts, but several friends attended. One of them mentioned the keynote by author Malcolm Gladwell, who said of family physicians, “If there’s a problem with (trust in) healthcare, there’s no solution without you.” He went on to say, “You can’t solve it with better technology. You can’t solve it with better drugs. You can’t solve it with a fancy EMR. We solve it with communication, listening, and empathy.”

Unfortunately, that doesn’t necessarily align with what many patients want, which is cheap, transactional service-oriented encounters. It will be interesting to see how the family medicine community responds to the challenge and whether people flock to the specialty or continue to retire early. Either way, I’ve got my calendar marked for next year’s conference in Chicago so I can see where things are trending.

What are your conference plans for the coming months? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/3/22

Major in the United States Army and a Maryland Doctor Facing Federal Indictment for Allegedly Providing Confidential Health Information to a Purported Russian Representative to Assist Russia Related to the Conflict In Ukraine

Federal prosecutors indict US Army Major Jamie Lee Henry and his wife, Anna Gabrielian, for conspiracy and disclosing the health information of military personnel to assist Russia with its war against Ukraine.

Talkspace investor demands appointment of CEO, plan to stabilize stock price

Investor Firstime Ventures calls for therapy app vendor Talkspace to appoint a permanent CEO, share its long-term plan, and address rumors of a potential sale.

Grow Therapy Raises $75 Million to Expand Access to Affordable Mental Healthcare

Tech-enabled mental healthcare company Grow Therapy raises $75 million in a Series B funding round, bringing its total raised to $90 million.

Careviso Raises Over $17 million in Series B Funding to Enhance Transparency and Access for Diagnostic Testing

Patient access and transparency technology vendor Careviso raises $17 million in a Series B funding round.

Monday Morning Update 10/3/22

Top News

Federal prosecutors indict US Army Major Jamie Lee Henry and his wife, Anna Gabrielian, for conspiracy and disclosing the health information of military personnel to assist Russia with its war against Ukraine.

Henry was a staff internist stationed at Fort Bragg, and Gabrielian an anesthesiologist working at Johns Hopkins during the time of the alleged conspiracy. They met several times with an undercover FBI agent posing as a Russian Embassy employee to stress their level of dedication to aiding Russia, eventually handing over the health information of a number of patients at Fort Bragg and Johns Hopkins to demonstrate their ability to access data they believed Russia could then exploit.

They both face up to 15 years in prison.

Reader Comments

From Jaffer Traish: “Re: The White House Conference on Hunger, Nutrition, & Health. Many announcements listed on the White House fact sheet of commitments. There is an important interop commitment outlined here.” The White House introduced a national strategy on hunger, nutrition, and health at a conference last week, incorporating five pillars that include ensuring public and private healthcare systems address the nutritional needs of all people. To do this, the government recommends screening for food insecurity, incentivizing providers and payers to conduct screenings for food insecurity and other social determinants of health, and supporting the data infrastructure necessary to do so. Traish refers to HL7’s Sync for Social Initiative, which aims to help healthcare stakeholders “better integrate nutrition information within a patient’s electronic health record by accelerating a standards-based approach to implementing universal social needs screening.” Committed participants include Oracle-Cerner, Meditech, Epic, and a number of health systems, payers, and other vendors.

HIStalk Announcements and Requests

Most poll respondents are in favor of creating a SWIFT-like network for healthcare similar to that of banking, although a significant number aren’t sure what all that involves.

New poll to your right or here: What should HHS do with the October 6 deadline for information sharing?

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

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

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

Acquisitions, Funding, Business, and Stock

Frustrated with Talkspace’s declining share price, lack of frontline leadership, and opaque business plans, investor Firstime Ventures calls for the therapy app vendor to appoint a permanent CEO, share its long-term plan, and address rumors of a potential sale. The company has reportedly received acquisition offers from Amwell and MindPath. It went public via a $1.4 billion SPAC in June 2021, but quickly lost stock market momentum. Its co-founder and CEO and head of clinical services both stepped down towards the end of 2021 due to lackluster Q3 results. Talkspace is likely still in the midst of a class-action lawsuit, filed earlier this year, that alleges it misled investors about its financials ahead of its IPO.

Sales

• Memorial Hermann Health System (TX) will switch from Oracle Cerner to Epic beginning early next year.
• EMedical Practice selects Sphere’s TrustCommerce payment processing software.
• Campbell County Health (WY) will go live on Epic next year.

People

Andrea Facini (Active Network) joins WebPT as chief product, marketing, and growth officer.

Verisma names GE Healthcare veteran Michael Fritts (Forced Physics DCT) COO, and promotes Julia Applegate to chief client officer.

Announcements and Implementations

Advata announces GA of Advata Smart AR, automated accounts receivable technology. The company was formed in June through the merging of six of Providence-owned Tegria legacy companies.

Verato develops Universal Identity technology, comprising patient data from EHRs, consumer data from CRMs and other demographic data sources, and provider data from national databases.

Allen County Regional Hospital (KS) goes live on Epic.

Meditech adds patient transport workflows, including an app for transport staff, to its Expanse EHR.

Government and Politics

Madigan Army Medical Center (WA) hosts a decommissioning ceremony for its Composite Health Care System. Science Applications International, now Leidos, was contracted to develop, design, and implement the system for the DoD in 1988. It rolled out across all military treatment facilities between 1992 and 1996, eventually running at 104 host sites with more than 100 interfaces with internal and external systems across the DoD and VA. It went live at Madigan in 1996, and experienced downtime only once, according to Col. (Dr.) David Owshalimpur, chief of nephrology at Madigan: “I always had it open during clinic days. If you knew the correct ‘cheat codes,’ you could fly through CHCS. It was also a much faster way to order labs, medications, and rads [radiological imaging] than AHLTA. So, CHCS was a nice backbone for both Essentris and AHTLA.” The medical center went live on MHS Genesis in 2017.

Other

Researchers at Houston Methodist develop analytics that predict hospitalization outcomes for geriatric patients with dementia on the first or second day of hospital admission with 95.6% accuracy. They hope to develop a corresponding mobile app for ICU and other hospital staff that will alert them to a patient’s likelihood of hospitalization and suggest interventions.

A survey of 115 healthcare executives finds that 55% believe integrating their disparate patient engagement capabilities will be a high priority in the coming year, though 84% believe it will be tough to accomplish with existing technology.

Sponsor Updates

• PerfectServe customer Bon Secours Mercy Health leverages the company’s Clinical Collaboration solution as part of its new Care Mobility project for nurse communication.
• Premier’s PINC AI Applied Sciences and partners AstraZeneca and Clinithink win a BWB Award for their use of technology-enabled healthcare solutions in the Digital Medicine category.
• RCxRules hosts a successful 2022 National User Conference.
• Surescripts releases a new There’s a Better Way: Smart Talk on Healthcare and Technology Podcast, “More is Not Always Better: Making Interoperability Work for Patients & Clinicians.”
• Upfront Healthcare achieves HITRUST risk-based, two-year certification to manage risk, improve security posture, and meet compliance requirements.
• Volpara Health wins a Gold Good Design Award for its Volpara Analytics mammography reporting and quality software.
• WebPT names Marcus Osborne (Walmart Health) to its Board of Directors.
• Wolters Kluwer Health acquires UK-based IJS Publishing Group, which offers peer-reviewed medical journals supporting scientists and authors.
• Vyne Medical will present at the MGMA Medical Practice Excellence: Leaders Conference October 9-12 in Boston.

Blog Posts

• Freezing the squeeze: The three A’s of efficiency (Nordic)
• Address Physician Burnout with Real-Time Prescription Benefit Tools (Arrive Health)
• How to Improve Patient Experiences and Reduce Healthcare Costs (PerfectServe)
• How Caregiving Has Changed Over the Years (Quil)
• Why you should attend Redox Connect Conference 2022 (Redox)
• Empower agents with AI call center capabilities (Talkdesk)
• Delivering on Denials: Novant’s Culture Creates Wins for Physicians, Patients, and Staff (Tegria)
• How to Create Better Physician Schedules: Integrating Technology and Data (TigerConnect)
• The Coming of Age of Cash-Based Practices (WebPT)
• How to enhance your experience when migrating to Epic (Verato)
• Zen Healthcare IT’s Guide to Understanding the Trusted Exchange Frameworks (Zen Healthcare IT)
• The Importance of Providing Meaningful Educational Resources to Your Patients (Zynx Health)

Contacts

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

Morning Headlines 9/30/22

Cerebral Treated a 17-Year-Old Without His Parents’ Consent. They Found Out the Day He Died.

The Wall Street Journal exposes lax patient identification verification at Cerebral, an online prescription drug company that has come under fire in recent months for potentially violating the Controlled Substances Act.

VA ‘not confident’ EHR issues preventing future rollouts are resolved following Oracle fix

VA Secretary Denis McDonough says it’s too soon to tell if an August EHR update by Oracle Cerner has finally fixed an “unknown queue” problem that caused thousands of clinical orders to disappear in an unmonitored inbox, causing patients to miss follow-up appointments.

Kahun Secures $8M Round for its ‘XAI’ Engine for Clinical Reasoning

Israel-based clinical assessment chatbot startup Kahun raises $8 million in a seed funding round.

News 9/30/22

Top News

The Wall Street Journal exposes lax patient identification verification at Cerebral, an online prescription drug company that has come under fire in recent months for potentially violating the Controlled Substances Act. An internal memo obtained by the paper says the company eschewed using its patient ID verification software because it slowed down the registration process, enabling some minors to receive treatment without parental consent. 

The company, which has raised $462 million, is facing an FTC investigation into its advertising and marketing, a federal inquiry into its prescribing practices, and the refusal of retail pharmacies like CVS and Walmart to fill its prescriptions.

Cerebral fired its founder and CEO in May and began laying off 350 employees in July.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Kidney care company InterWell Health acquires Acumen Physician Solutions, the nephrology-focused EHR and practice management software division of Fresenius Medical Care. Acumen’s offerings include technology co-developed with Epic. Fresenius’ value-based care division, Fresenius Health Partners, merged with Cricket Health and InterWell last month.

Tech-enabled, senior-focused mental healthcare startup Rippl launches with $32 million in seed funding. The company will initially offer its virtual and home-based care programs through payers in the Seattle area.

People

Avel ECare promotes Kelly Rhone, MD to chief medical officer.

Dave Cassel (Safe Health Systems) joins Health Gorilla as SVP of customer success and operations.

Keltie Jamieson (Horizon Health Network) joins the Bermuda Hospitals Board as CIO ahead of its Cerner go-live next month.

Announcements and Implementations

Particle Health develops an API enabling EHR vendors to connect their customers to Carequality, CommonWell, and EHealth Exchange.

Christus Southeast Texas Health System launches a stroke-detection program using telestroke services from TeleSpecialists and care coordination software from Viz.ai.

Government and Politics

The FDA issues new guidance for clinical decision support software that should be regulated as medical devices, including AI-powered technologies that predict the likelihood of sepsis, heart-failure hospitalizations, and/or patient deterioration; as well as software that flags patients who may be addicted to opioids.

A GAO analysis of telehealth services used by Medicare beneficiaries between April 2019 and December 2020 finds that use of services increased from 5 million to 53 million visits – an increase in keeping with the temporary waiver of certain Medicare restrictions on telehealth during the pandemic, and that 5% of providers delivered 40% of services. Analysts recommend that CMS offer providers more concrete guidance on billing for audio-only visits, require providers to identify when virtual visits are conducted in patient homes, and assess the quality of virtual care delivered during the pandemic. It also recommends that OCR offer providers guidance on how to explain privacy and security risks to telemedicine patients.

VA Secretary Denis McDonough says it’s too soon to tell if an August EHR update by Oracle Cerner has finally fixed an “unknown queue” problem that caused thousands of clinical orders to disappear in an unmonitored inbox, causing patients to miss follow-up appointments. “We continue to have concerns about queues, unknown queues, unknown kind of areas where … veterans may end up,” he said. “I think that concern is significant enough that we’re not talking about a single, discrete issue that would suggest … a single discrete fix. But rather, they’re a pretty fundamental set of improvements. We’re continuing to make assessments about how big the challenge is.”

Other

Hurricane Ian leaves catastrophic damage caused by severe flooding, high winds, and power outages after hitting Florida’s West Coast Wednesday. Staff at HCA Florida Fawcett Hospital in Port Charlotte saw the ICU flood after its roof was blown off, and storm surge flood the lower level emergency room.

Sponsor Updates

• NTT Data sponsors The Children’s Inn Golf INNvitational.
• First Databank names Brittany Pritsch and Jasmine Stuckey research associates, and Nikki Sleeper regional manager.
• Get Well publishes a new case study, “Putting the patient first in digital care management.”
• Intelligent Medical Objects publishes a new case study featuring the University of Manchester, “Enhancing NLP with clinical terminology.”
• Netsmart announces its intent to become a Qualified Health Information Network.
• Sultan Bin Abdulaziz Humanitarian City in Dubai extends its contract with InterSystems for another five years.
• Clearsense publishes a new infographic, “6 Questions for Healthcare Data Transparency.”
• Zynx Health introduces a complimentary Monkeypox order set and care plan bundle.

Blog Posts

• The medical problem list toolkit (Intelligent Medical Objects)
• Execution Over Perfection: Use the ‘Gift of Constraints’ to Help Your Rehab Therapy Clinic Succeed (Net Health)
• AI in Radiology, part 5: How to amplify the impact of radiology reporting (Nuance)
• What’s a vCISO and Why Do You Need One? (Optimum Healthcare IT)
• Physician EHR as a Detriment to Patient Experience? (ChartLogic)

Contacts

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

EPtalk by Dr. Jayne 9/29/22

I spent some time in the wilderness this week, in an attempt to catch up on some sorely needed rest and relaxation. Unfortunately, changing time zones wasn’t terribly helpful on the rest piece, but there was definitely some relaxation and a lot of silliness as a group of adults tried to assemble a complicated Lego set while under the influence of cocktails. I had identified goals for this journey including completion of two specific hikes that I wasn’t able to manage on a previous trip. Although the first one was a success and helped me adjust to the altitude, the main event was a bust. I’m surprisingly OK with it and suppose I’ve reached the point in my life where the journey is equally as important as the destination, if not more. After my recent exposure to a patient injured while traveling, I’m also beyond grateful that the only problem I experienced was a close encounter between my favorite hiking pants and some tenacious tree sap.

It feels like everyone I know in the healthcare IT world is talking about the planned October 6 deadline for organizations to comply with the HHS information-sharing rule. Many care delivery organizations are relying on their EHR vendors to ensure compliance, which, depending on the vendor, has led to a flurry of last-minute upgrades. From what I hear around the virtual water cooler, vendor readiness has ranged from “competent” to “clueless,” with many vendors missing deadlines and others who are not communicating their status. This week, a group of high-profile stakeholders (including CHIME, the American Academy of Family Physicians, The American Hospital Association, and others) sent a plea to the Secretary of the US Department of Health and Human Services in an attempt to postpone the deadline. The letter asks for a one-year extension in addition to using warning communications before entities are subject to formal investigations or fines.

Reasons for a delay include: inability to support access to and exchange of electronic health information (EHI); lack of definition around EHI and confusion around the Office of the National Coordinator’s (ONC) EHI infographic; confusion on how exceptions can be applied when information cannot our should not be exchanged; concern around the protection of sensitive information such as drug use, mental health, and reproductive information; and lack of responsiveness to questions submitted to ONC. Specifically, from the patient perspective, the letter cites “the harm occurring when laboratory results and reports are released in instances of life threatening or life limiting diagnoses.” As someone who has been in that situation – which is hard to cope with even when you’re a practicing physician with medical knowledge and not just the average patient – I can support that concern completely. There will be harm, but it’s going to be impossible to quantify. If this effort were a research project, I can’t imagine the Institutional Review Board that would approve it.

Less exciting but also coming in October: it’s time for the annual updates to the ICD-10 database, effective October 1. Codes can be added, deleted, or revised. Incorrect coding can lead to payment delays or denials, so I hope everyone’s vendors and technology teams have this adequately covered. Some of the changes are certainly reflective of the times we’re living in, including: expansion of codes for various substance use disorders, indicating that the disorders are in remission; additional codes for reactions to severe stress; addition of codes for accidents related to electric bicycles; and three new codes for problems related to housing and economic circumstances. Other codes that caught my attention include six new codes for fractures related to cardiopulmonary resuscitation (CPR) and two additions for patient noncompliance with medical advice.

I was excited to see data released by Blue Cross NC addressing the increase in use of telehealth services. The company recently completed a two-year review of telehealth claims data. Based on recent trends, those covered by its policies will have access to 77 additional telehealth services effective January 1, 2023. Interesting data points: in 2020, the plan saw a 7,500% increase in telehealth claims; telehealth accounted for 47% of behavioral health visits and 10% of family medicine visits, but only 2% of specialist visits. The data is a little murky, though, because family medicine and pediatrics are listed separately from “primary care,” so I’m not sure what’s going on there, since both specialties are clearly considered primary care. I was amused by the fact that although the company’s spokesperson said the changes are “so members can access easy, affordable care no matter where they live,” the new policy specifically excludes members receiving care from out-of-state providers. Looks like vacationers might be incentivized to be less than truthful about their physical location in the name of better coverage.

Those who know that telehealth services won’t be covered by insurance might want to make sure they’re accessing care from a trusted site. One of my colleagues recently had a direct-to-consumer telehealth experience when they were trying to get relief from a rash that might have been related to insect bites but was instead told that they had been infected by flesh-eating bacteria. Although they requested a refund on the visit it was less than timely, and I’m pretty sure they’ll never use that vendor again.

Recently, I’ve been inundated with LinkedIn requests. Although some of them have been legitimate and likely triggered by networking at the recent Epic User Group meeting, others are entirely spammy. Word to the wise: I’m not going to accept your connection request if your profile doesn’t have a picture, only includes your first name, or if you’re asking me to buy something. Another pet peeve: those who prefix their names with “Dr.” without any credentials on their profile. I received a request today from someone I’ll anonymize as “Dr. Harley” and neither his first name nor his last name included “Harley.” Unless you’re a top-notch motorcycle mechanic, I’m not sure what you’re gaining by styling yourself this way.

Have you seen a burst of LinkedIn requests? Do you find them useful at all or just annoying? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/29/22

InterWell Health Enhances Capabilities to Transform Kidney Care with Addition of Acumen Physician Solutions

Kidney care company InterWell Health acquires Acumen Physician Solutions, which offers EHR and practice management software for nephrologists.

New Mental Health Company Led by Consumer Brand Industry Veterans to Revolutionize Mental Health Care Delivery for Seniors

Tech-enabled, senior-focused mental healthcare startup Rippl launches with $32 million in seed funding.

10 Healthcare Organizations Band Together to Urge HHS to Postpone Information Sharing Compliance Deadlines

Citing a lack of guidance on best practices and potential enforcement, plus a lack of preparedness on the part of some smaller vendors, provider organizations band together to urge HHS to give stakeholders an additional year to comply with the information-sharing compliance deadline, currently scheduled for October 6, 2022.